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Review Question - QID 109830

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QID 109830 (Type "109830" in App Search)
A 27-year-old man presents to his primary care physician for a general checkup. The patient is a college student who is studying environmental science. He is doing well this semester and is having fun in his classes. He has a medical history of asthma and constipation but is currently not taking any medications. The patient hopes to have a form signed that will allow him to participate in intramural sports. His temperature is 98.6°F (37°C), blood pressure is 118/74 mmHg, pulse is 82/min, and respirations are 12/min. The patient is an obese but otherwise healthy young man. Cardiopulmonary exam and abdominal exam are within normal limits. Dermatologic exam is notable for the findings in Figure A. These lesions are also identified in the anogenital region. Which of the following is the most appropriate next step in management for this patient?
  • A

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

  • A

Select Answer to see Preferred Response

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.

ILLUSTRATIONS:
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