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A 46-years old female was referred from the rheumatology department with diffuse skin lesions. She had been diagnosed with rheumatoid arthritis in 2006 and initially underwent treatment with a combined regimen of methotrexate (MTX, 12.5 mg per week), prednisolone (2.5 mg per day) and leflunomide (10 mg per day). Due to the poor response, leflunomide was substituted to adalimumab (40 mg every other week) in September 2014 after negative screening for viral hepatitis and tuberculosis. 6 months into the combined therapy of adalimumab, prednisolone and methotrexate, the patient developed multiple, tiny erythematous to skin-colored papules and referred to the department of dermatology. On close examination, she presented with tender and pruritic, multiple, 0.1-0.2 cm-sized, slightly erythematous papules on the mons pubis and the Lt. lower leg (Figure 1). The patient was HIV negative and her laboratory assessment was normal. Molluscum contagiosum infection was suspected after curettage but a punch biopsy was performed from the the mons pubis and the left lower leg for confirmation. The histopathologic examination showed circumscribed multilobular epithelial proliferation with central keratinization. Diffuse lymphocytic infiltration and intracytoplasmic inclusions were also observed (Figure 2). Based on clinical and pathologic findings, diagnosis of diffuse molluscum contagiosum was made. To prevent further spread of the molluscum, adalimumab was withdrawn from the regimen. Although we explained the possibility of persistence and spread of the molluscum lesions, the patient refused to undergo extraction of the lesions. No recurrence of molluscum from the biopsy site or further spreading was observed at 8 months follow-up.

journal of clinical and investigative dermatology

A Case of Molluscum Contagiosum in an Adult Patient with Rheumatoid Arthritis, Following Combination Therapy with Adalimumab, Methotrexate and Prednisolone