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Approve the patient to participate in intramural sports
7%
4/57
Cryotherapy
21%
12/57
Fasting blood glucose
4%
2/57
Testing for human immunodeficiency virus
67%
38/57
Topical keratolytics
0%
0/57
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This patient is presenting with diffuse lesions of molluscum contagiosum in the anogenital region which could be associated with a new human immunodeficiency virus (HIV) infection. HIV testing should be performed in order to rule out this infection.Molluscum contagiosum is typically a benign process caused by a poxvirus. If an isolated lesion is found, treatment is typically conservative and can include observation or cryotherapy. If there are multiple disseminated lesions, or many lesions in the anogenital region, then an immunocompromised state should be suspected and the patient should be worked up for HIV. Patients who are diagnosed with HIV need to undergo immediate treatment with highly active antiretroviral therapy.Figure/Illustration A is a clinical photograph demonstrating pink, pearly, umbilicated lesions (red circles). These lesions are characteristically seen in molluscum contagiosum.Chen et al. review the evidence regarding the diagnosis and treatment of patients with molluscum contagiosum. They discuss how these patients can have multiple lesions in immunodeficiency states. They recommend understanding the underlying etiology for patients with multiple eruptions.Incorrect Answers: Answer 1: Approving the patient to participate in intramural sports neglects this patient's suspicious, sudden eruption of lesions suggestive of molluscum contagiosum. Patients who have suspected HIV need to have this potential etiology worked up prior to clearance. Answers 2 & 5: Cryotherapy and topical keratolytic agents could be performed for an isolated lesion in an aesthetic location; however, it would not be indicated for multiple lesions which could be indicative of a more serious process. Patients with many lesions need to be worked up for immunodeficiency processes such as HIV.Answer 3: Fasting blood glucose would be indicated in an obese patient; however, testing for HIV would be more important in this patient with multiple dermatologic lesions. Metformin is the first-line treatment for patients with type 2 diabetes. Bullet Summary: A sudden eruption of diffuse molluscum contagiosum lesions or lesions in the anogenital region requires workup for HIV.
4.7
(7)
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