Images in Medicine - Molluscum Contagiosum and Job's'syndrome

A three-and-half-year-old male child presented with fever, cough and peathlessness of four day's duration. The child was diagnosed as a case of Job's'syndrome (Hyper-IgE'syndrome) at the age of two years (IgE level: 15062 IU/ml; reference range: 10-180 IU/ml) and had previous three admissions for lower respiratory tract infections. The child had respiratory distress and crepitations were heard bilaterally. He also had multiple papular lesions'scattered on the face and the neck (Figure 1). These were diagnosed as molluscum contagiosum on a'skin biopsy (Figure 2). The chest radiograph revealed ponchopneumonia with multiple pneumatocoeles in both the lungs. Investigations revealed anaemia (haemoglobin: 7.3 g/dl; PCV: 25%), leukocytosis (count of 25,900 cells/cumm), eosinophilia (absolute eosinophil count of 518 cells/cumm), high ESR (55 mm at 1 hr), hypoxia on arterial blood gas analysis and normal liver and renal function tests. Coagulase negative'staphylococcus was isolated from the'skin'swab. The patient was treated with oxygen, intravenous fluids and intravenous vancomycin and amikacin (for 14 days). The extraction of'some of the molluscum contagiosum lesions was performed. For the remaining lesions, the child is on treatment with topical Tretinoin cream (0.05% locally).