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Molluscum IRIS — SCE Infectious Diseases MCQ

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EasyHIV MedicineMolluscum IRISSCE Infectious Diseases

A 45-year-old man with HIV develops molluscum contagiosum — extensive facial lesions (>50 umbilicated papules). CD4 is 80. He starts ART. After 6 weeks, many lesions become inflamed and some enlarge dramatically before flattening. What has occurred?

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Correct answer: E — Molluscum-IRIS — immune reconstitution causes inflammation of pre-existing molluscum lesions; this is paradoxical worsening that typically resolves spontaneously; continue ART

Molluscum-IRIS is a common cutaneous IRIS presentation. Immune reconstitution triggers inflammation directed at molluscum contagiosum virus in existing lesions, causing erythema, swelling, and sometimes pustulation. This is paradoxical worsening that ultimately leads to lesion resolution. Continue ART. Symptomatic treatment only if needed. Most lesions will clear over 2-4 months as immune reconstitution progresses.

Reference: BHIVA 2022 – IRIS; BAD 2023 – Molluscum