ORAL WARTS IN A PEDIATRIC PATIENT WITH TRISOMY 21 SUCCESSFULLY TREATED WITH HUMAN PAPILLOMAVIRUS VACCINE

Abstract

<h3>Introduction</h3> Trisomy 21 is associated with immune dysregulation through overexpression of interferon genes on chromosome 21, affecting innate and humoral immunity. Patients with Trisomy 21 have high rates of infections, notably of the respiratory tract as well as otitis media and periodontal disease. We present the case of a 5-year-old male with Trisomy 21 with extensive oral warts successfully treated with Recombinant Human Papillomavirus vaccination. <h3>Case Description</h3> A 5-year-old male with Trisomy 21, atrioventricular canal defect, asthma, and obstructive sleep apnea was referred to Pediatric Allergy and Immunology for evaluation of numerous oral cutaneous warts refractory to treatments including cimetidine and topical compounded cidofovir. Biopsy revealed HPV positivity with low-risk strains, 6 and 11. The patient received 2 doses of 9-valent Human Papillomavirus vaccine, which includes strains 6 and 11, with near complete resolution and no appreciated side effects. <h3>Discussion</h3> To our knowledge, this is the first case of the treatment of oral HPV with HPV vaccine in a pediatric patient with Trisomy 21. Presently, the 9-valent recombinant HPV vaccine is approved for ages 9-45. A review of the literature highlights the use of the quadrivalent vaccine in HIV-positive children ages 7-12, however it is not routinely given in younger patients with primary immunodeficiency. One prior case report detailed the successful treatment of recurrent laryngeal papillomatosis in a healthy 2-year-old. Our case demonstrates a clear immune response as elicited by the resolution of his warts and highlights the potential for expanded use of HPV vaccination in pediatric patients with immune dysregulation.