If multiple molluscum contagiosum nodules are present, which systemic condition is often associated?

• A. Diabetes mellitus
• B. HIV
• C. Hypertension
• D. Hypothyroidism

Answer: (B)

Multiple molluscum contagiosum nodules point to a weakened cell-mediated immune response. The body’s control of the molluscum virus relies largely on T-cell–mediated immunity, so when immunity is compromised—most notably with HIV infection—the lesions tend to proliferate, become numerous, and persist longer. In people with normal immune function, molluscum tends to present as a few lesions that often resolve on their own. Because extensive molluscum can be a sign of HIV-related immunosuppression, seeing many nodules should prompt consideration of HIV testing and an immune-status evaluation. The other conditions listed don’t typically create a pattern of widespread molluscum; diabetes, hypertension, and hypothyroidism aren’t associated with this presentation in the same way.