Successful Treatment of Perianal Giant Condyloma Acuminatum in an Immunocompromised Host With Systemic Interleukin 2 and Topical Cidofovir

Abstract

A 46-year-old man presented for evaluation of large recurrent growths around the anus and rectum. He had been diagnosed as having chronic lymphocytic leukemia at age 36 years and was treated with fludarabine phosphate, cyclophosphamide, and rituximab at age 42 years, with successful induction of remission. His disease returned 3 years later, and while undergoing chemotherapy with the same regimen, he developed perianal and penile skin lesions. The penile lesions cleared with serial treatment with cryotherapy, imiquimod, and sinecatechins, to which the perianal lesions were refractory. He underwent 2 surgical debulking procedures for the rapidly progressive perianal lesions, which exhibited aggressive regrowth within 2 weeks of each debulking. Physical examination revealed a large (>10 cm in diameter), circumferential (but not occluding the rectum), exophytic, friable perianal mass with punctate bleeding, consistent with giant condyloma acuminatum (GCA). An adjacent 3-mm papule with corymbiform surface consistent with a common wart was also noted (Figure 1). The patient reported considerable rectal pain and bleeding due to the anal condyloma. The perianal mass demonstrated severe squamous dysplasia, with focal areas concerning for squamous cell carcinoma in situ on histopathologic examination. The remaining findings from examination were unremarkable.