Jomsky Melissa, Summa Christian Hailey, Zarraga Matthew B, Demory Beckler Michelle
Biomedical Sciences, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA.
Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA.
Cureus. 2022 Aug 4;14(8):e27679. doi: 10.7759/cureus.27679. eCollection 2022 Aug.
Anogenital warts are considered one of the most common sexually transmitted infections caused by the human papillomavirus (HPV). One of the primary considerations with HPV is the virus's high rate to develop into squamous cell carcinoma (SCC). SCC is one of the leading causes of skin cancer with a variety of treatment options. The gold standard of treatment for SCC is surgical excision. Complications may arise for those that are considered immunocompromised, or lack of efficacy may be taken into consideration for nonsurgical approaches. Herein, we suggest prompt diagnosis and treatment with photodynamic therapy (PDT) of HPV lesions to prevent disease progression and reoccurrence. The patient is a 54-year-old male nonsmoker with a past medical history of squamous cell carcinoma and HIV and presented with a perianal rash. Additionally, he confirmed associated symptoms of itchiness, irritation, and pain. At the time of his appointment, his CD4 count was 121 cells/µL, and he stated he was compliant with his antiretroviral therapy. Based on history and physical examination, the patient was empirically treated with oral fluconazole and topical nystatin-triamcinolone for two weeks. At follow-up, symptomatology worsened, and a biopsy was performed. Squamous cell carcinoma in situ was confirmed histologically. A secondary bacterial skin infection developed at the biopsy site. At this point, PDT was recommended due to compromised tissue and further risk of infection. At present, a gold standard of care for HPV infection does not exist. Prompt diagnosis and treatment of these lesions are important to recognize due to the high risk of the development of squamous cell carcinoma. Complications of secondary bacterial infections can arise with current treatment for squamous cell carcinoma, particularly in the immunocompromised. Non-surgical approaches for HPV have been less than desirable with higher recurrence rates of HPV lesions. Herein, we suggest the consideration of PDT treatment for HPV and SCC.
肛门生殖器疣被认为是由人乳头瘤病毒（HPV）引起的最常见的性传播感染之一。HPV的一个主要问题是该病毒发展为鳞状细胞癌（SCC）的几率很高。SCC是皮肤癌的主要病因之一，有多种治疗选择。SCC的治疗金标准是手术切除。对于免疫功能低下的患者可能会出现并发症，或者对于非手术方法可能会考虑其疗效不佳的情况。在此，我们建议对HPV病变进行光动力疗法（PDT）的及时诊断和治疗，以防止疾病进展和复发。患者为一名54岁男性，不吸烟，有鳞状细胞癌和HIV病史，出现肛周皮疹。此外，他确认伴有瘙痒、刺激和疼痛等相关症状。在他就诊时，他的CD4细胞计数为121个/微升，他表示自己坚持抗逆转录病毒治疗。根据病史和体格检查，该患者经验性地接受了口服氟康唑和外用制霉菌素 - 曲安奈德治疗两周。在随访时，症状加重，进行了活检。组织学确诊为原位鳞状细胞癌。活检部位发生了继发性细菌性皮肤感染。此时，由于组织受损和进一步感染风险，建议采用PDT。目前，HPV感染尚无护理金标准。由于鳞状细胞癌发展的高风险，及时诊断和治疗这些病变很重要。鳞状细胞癌的当前治疗可能会出现继发性细菌感染的并发症，特别是在免疫功能低下的患者中。HPV的非手术方法不太理想，HPV病变的复发率较高。在此，我们建议考虑对HPV和SCC进行PDT治疗。
