title: Molluscum contagiosum surrounded by a white halo and Sezary syndrome.
abstract: BACKGROUND
  Molluscum contagiosum (MC) is caused by a DNA virus of the poxvirus group. It is common in children, and is also found in sexually active adults and HIV-seropositive patients. Cellular immunity is essential to controlling MC virus infection. We report the first observation of a patient with stage IV Sezary syndrome, who presented multiple molluscum contagiosum, spread and surrounded by a pale halo.
  
  
  METHODS
  A woman aged 70 presented with aggravation of Sezary syndrome diagnosed in 2009 and treated with topical corticosteroids. The examination showed a generalized pruritic exanthem and multiple flesh-coloured papules from 1 to 3 mm, spread over the entire skin surface and surrounded by a white halo. Histological examination of a lesion showed the presence of infected cells with intracytoplasmic inclusions infected in an acanthotic epidermis, surrounded by a melaninopenic hypomelanosis with a normal melanocyte density. There was no inflammatory character. The diagnosis of multiple molluscum contagiosum was given, the application of clobetasol propionate was suspended and treatment with chlorambucil 4 mg/day and prednisone 0.5 mg/kg/day was started. The evolution of the rash and pruritus was rapidly favourable. After 3 months, the rash and pruritus had regressed. There was no molluscum contagiosum or clear halo.
  
  
  CONCLUSIONS
  We report the original observation of a patient with stage IV Sezary syndrome, who presented multiple molluscum contagiosum, spread and surrounded by a pale halo, without inflammation, eczema or disappearance of melanocytes. This halo could be due to the secretion of a protein by molluscum contagiosum inhibiting inflammation around this MC. To our knowledge, this phenomenon reported in a patient with severe atopic dermatitis associated with Sezary syndrome has not previously been described.
authors.affiliation: Service de dermatologie, bâtiment des spécialités médicales, CHU de Nancy allée du Morvan, Vandoeuvre-les-Nancy, France.
authors.forename: C
authors.initials: C
authors.lastname: Le Treut
authors.affiliation: Service de dermatologie, bâtiment des spécialités médicales, CHU de Nancy allée du Morvan, Vandoeuvre-les-Nancy, France.
authors.forename: F
authors.initials: F
authors.lastname: Granel-Brocard
authors.affiliation: Service de dermatologie, bâtiment des spécialités médicales, CHU de Nancy allée du Morvan, Vandoeuvre-les-Nancy, France.
authors.forename: A-C
authors.initials: AC
authors.lastname: Bursztejn
authors.affiliation: Service de dermatologie, bâtiment des spécialités médicales, CHU de Nancy allée du Morvan, Vandoeuvre-les-Nancy, France.
authors.forename: A
authors.initials: A
authors.lastname: Barbaud
authors.affiliation: Service d'anatomopathologie, hôpital Brabois, CHU de Nancy allée du Morvan, Vandoeuvre-les-Nancy, France.
authors.forename: F
authors.initials: F
authors.lastname: Plénat
authors.affiliation: Service de dermatologie, bâtiment des spécialités médicales, CHU de Nancy allée du Morvan, Vandoeuvre-les-Nancy, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Schmutz
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D004485:Eczema / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D008976:Molluscum Contagiosum / Q000150:complications* / Q000175:diagnosis; D012751:Sezary Syndrome / Q000150:complications* / Q000175:diagnosis; D012867:Skin / Q000473:pathology*