Disfiguring Generalized Verrucosis in an Indonesian Man With Idiopathic CD4 Lymphopenia

Abstract

Human papillomavirus (HPV) infections cause a spectrum of clinical disease states, depending on the causative HPV and the characteristics of the infected host, especially the status of cell-mediated immunity. Generalized verrucosis is an unusual clinical presentation of a disseminated HPV infection associated with severe immunodeficiency status. We present a case of extreme disfigurement associated with an HPV-2 (common wart virus) infection. Virologic studies, immune status of the patient, and treatment(s) are summarized. The severe disfigurement of this patient was a result of an underlying severe immunodeficiency, permissive for a disseminated HPV-2 infection that was allowed to progress for many years before the initiation of therapy. Such a rare case illustrates the natural history of generalized verrucosis in the setting of severe immunodeficiency in the absence of sustained medical interventions. Medical and surgical treatments resulted in marked improvement in the general health of this patient, as well as improvement of the disfigurement that resulted from the generalized verrucosis.