If multiple molluscum contagiosum nodules are present, which infection should be suspected?

• A. HIV
• B. CMV
• C. HPV
• D. HSV

Answer: (A)

When molluscum contagiosum presents with many nodules, think about underlying immunosuppression, especially HIV infection. In healthy individuals, molluscum usually causes a few small, centered papules, but in people with HIV/AIDS the lesions can become numerous, larger, and more widespread due to impaired cell-mediated immunity allowing greater viral replication. Because extensive molluscum can be an indicator of advanced immunosuppression, HIV testing and assessment of immune status are important.

The other infections listed don’t typically produce a pattern of numerous molluscum nodules. CMV is an opportunistic infection affecting organs like the retina and GI tract rather than causing a cluster of molluscum lesions; HPV causes warts, not molluscum nodules; HSV presents as grouped vesicular lesions rather than discrete molluscum papules.