A Severe Case of Molluscum Contagiosum Immune Reconstitution Inflammatory Syndrome in a Patient with Human Immunodeficiency Virus

Paradoxical immune reconstitution inflammatory syndrome (IRIS) in human immunodeficiency virus (HIV)-positive patients initiating antiretroviral treatment (ART) is caused by restored immunity to specific antigens, resulting in worsening of a pre-existing infection. Molluscum contagiosum (MC) is commonly noted in HIV-positive individuals but ART alone is usually sufficient to bring about resolution. We present a rare case of severe MC-IRIS that worsened despite immune reconstitution. LEARNING POINTS: Molluscum contagiosum is a common opportunistic infection which can have severe manifestations in immunocompromised individuals. Antiretroviral treatment alone is usually sufficient to clear the infection, however refractory cases can persist despite immune reconstitution. Failure to improve or worsening immune reconstitution inflammatory syndrome should raise suspicion for additional immunological dysfunction. Surgery, cytodestructive therapies and chemotherapeutic agents can be considered in extensive, persistent disease.