Multiple bilateral eyelid molluscum contagiosum lesions associated with TNFalpha-antibody and methotrexate therapy

Am J Ophthalmol. 2002 Aug;134(2):270-1. doi: 10.1016/s0002-9394(02)01499-x.


Purpose: To demonstrate a patient developing multiple bilateral eyelid molluscum contagiosum lesions after initiation of TNFalpha-antibody therapy for rheumatoid arthritis.

Design: Single interventional case report.

Methods: Clinical, histopathologic, and immunologic-serological findings are presented.

Results: A 67-year-old patient with a 5-year history of rheumatoid arthritis had been treated with prednisone and methotrexate for the last 5 years. After initiation of additional TNFalpha-antibody treatment, complaints from rheumatoid arthritis subsided, but multiple bilateral molluscum contagiosum lesions of upper and lower eyelids occurred despite normal or only slightly reduced CD(4) (420-178/ microl) and CD(8) counts (143-58/microl). Histopathologic evaluation of the excised warts confirmed the clinical diagnosis. Under continued therapy, the warts have been recurring for 12 months.

Conclusion: TNFalpha-antibody treatment for rheumatoid arthritis may compromise the host response to molluscum contagiosum, especially if methotrexate is given additionally. Patients should be informed about this potential complication.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antibodies, Monoclonal / adverse effects*
  • Arthritis, Rheumatoid / drug therapy
  • CD4 Lymphocyte Count
  • CD4-CD8 Ratio
  • CD4-Positive T-Lymphocytes / immunology
  • CD8-Positive T-Lymphocytes / immunology
  • Drug Therapy, Combination
  • Eye Infections, Viral / chemically induced*
  • Eye Infections, Viral / pathology
  • Eye Infections, Viral / surgery
  • Eyelid Diseases / chemically induced*
  • Eyelid Diseases / pathology
  • Eyelid Diseases / surgery
  • Female
  • Humans
  • Infliximab
  • Methotrexate / adverse effects*
  • Molluscum Contagiosum / chemically induced*
  • Molluscum Contagiosum / pathology
  • Molluscum Contagiosum / surgery
  • Opportunistic Infections / chemically induced
  • Opportunistic Infections / pathology
  • Opportunistic Infections / surgery
  • Recurrence
  • Tumor Necrosis Factor-alpha / immunology*
  • Warts / chemically induced
  • Warts / pathology
  • Warts / surgery


  • Antibodies, Monoclonal
  • Tumor Necrosis Factor-alpha
  • Infliximab
  • Methotrexate