Disseminated molluscum contagiosum in a patient with chronic lymphocytic leukaemia after alemtuzumab

Abstract

A 62-year-old man was diagnosed as Rai stage IV B-cell chronic lymphocytic leukaemia (CLL) in 2001. He did not achieve any response to four courses of oral chlorambucil, so he received treatment with intravenous fludarabine attaining partial remission. This, however, lasted only 4 weeks. Intravenous alemtuzumab was administered intravenously at a dose of 30 mg three times a week for 12 weeks (after an initial dose of 3 mg). After treatment, a partial nodular response in the bone marrow was achieved, the splenomegaly was reduced by > 50%, the enlarged lymph nodes disappeared, and the CD4-positive T-lymphocyte count decreased from 30 cells to 3 cells/mm3. One week after completion of therapy with alemtuzumab, the patient developed a fever again with multiple flesh-coloured umbilicated papules, located everywhere (top). Skin biopsy confirmed the clinical diagnosis of molluscum contagiosum (bottom). Molluscum contagiosum frequently occurs as an opportunistic infection in immunocompromised patients, and there seems to be a correlation between the extent and severity of molluscum contagiosum and lower CD4-positive T-lymphocyte counts. Alemtuzumab also has a significant activity in fludarabine-treated CLL patients, even if severe immunosuppression frequently occurs.