Tubercular Empyema with Molluscum Contagiosum and Cutaneous Metastasis in a Patient with Prior Glossectomy and Subsegmental Mandibulectomy: A Rare Case Report

Abstract

Tubercular Empyema (TE) is an uncommon manifestation of extrapulmonary tuberculosis, and its coexistence with molluscum contagiosum is exceedingly rare. Molluscum Contagiosum (MC) typically affects children, so its occurrence in a 46-year-old male might raise suspicion of immune suppression. The simultaneous occurrence of these infections in a patient with cutaneous metastasis and a prior history of oral carcinoma surgery presents a unique diagnostic and therapeutic challenge. The patient in the present case report was apparently in good health until 7 months ago when he developed intermittent episodes of fever not associated with chills or rigors. During the same period, he experienced shortness of breath when walking short distances, graded as Modified Medical Research Council (MMRC)+2, which subsided with rest. He also reported localised lower back pain for the past 7 months, accompanied by loss of appetite. Over the past 2 years, he experienced unintentional weight loss of approximately 10 kg. There was no history of orthopnea, paroxysmal nocturnal dyspnea, haemoptysis, palpitations, wheezing, or sore throat. He denied any nausea, vomiting, seasonal or diurnal variation in symptoms and had no history of biomass exposure. The patient reported exposure to a pet dog and had no history of drug allergies. He also presented with right-sided pleural effusion, cutaneous molluscum contagiosum, and metastatic squamous cell carcinoma confirmed on biopsy. Imaging revealed multiloculated collections with bony erosion suggestive of tuberculosis. He received anti-tubercular therapy, antibiotics, and analgesia, showing partial improvement, with oncology follow-up advised for metastatic disease management.