Efflorescence of acquired epidermodysplasia verruciformis due to immune reconstitution inflammatory syndrome-like mechanisms following anti-HPV vaccination in a HIV-positive patient

Abstract

Epidermodysplasia verruciformis (EV) is a rare cutaneous pre-cancerous condition characterized by presence of flat, scaly macules, verruca-like papillomatous papules, seborrheic keratosis-like lesions, and pink-red pityriasis versicolor-like macules. The disease is caused by abnormal susceptibility to certain specific beta-HPV subtypes, most commonly 5 and 8. Classic EV is genetically determined, but in immunocompromised individuals, an acquired form can occur. Only 48 cases of acquired EV (AEV) in people living with HIV have been described. We describe a case of AEV in a 36-year-old HIV-positive man with an history of stable optimal CD4 cell count and undetectable HIV viral load. The AEV significantly deteriorated after the administration of the second dose of the quadrivalent anti-HPV vaccine and did not improve despite local treatment, anti-HPV vaccination completion, and persistently optimal combined antiretroviral treatment adherence. To the best of our knowledge, this is the first report of an AEV deterioration with a clinical and temporal pattern mimicking an immune reconstitution inflammatory syndrome (IRIS) following anti-HPV vaccination, instead of low CD4 count restoration. After reviewing the current literature, we have hypothesized a vaccine-mediated IRIS-like phenomenon in the pathogenesis of the disease.

Unveiling the Therapeutic Horizon: HPV Vaccines and Their Impact on Cutaneous Diseases—A Comprehensive Review

“…Furthermore, while our selected cases exhibited successful treatment of AEV, a distinct outcome was observed in a male patient with HIV. Post the second dose of the qHPV vaccine, his AEV significantly deteriorated, showing no signs of improvement despite local therapy, completion of the vaccine regimen, and antiretroviral treatment, which evoked a hypothesis suggesting a vaccine-induced occurrence analogous to immune reconstitution inflammatory syndrome (IRIS) [ 106 ].…”

Photodynamic Therapy Used to Treat an HIV Patient with an Efflorescence of Viral Warts after HAART Therapy

“…Occurrence of these eruptive warts may be explained as a consequence of immune reconstitution inflammatory syndrome (IRIS). Interestingly, another instance of an IRIS-like syndrome has been reported in the literature, although in this case it occurred concurrently with the HPV vaccine [ 17 ]. Since the immune reconstitution phase of the patient following HAART was still ongoing, and without a fully regained count of CD4+ lymphocytes, we hypothesised that the number of antigens exposed upon application of PDT therapy was high enough to compensate for the deficiency of CD4+ lymphocytes and to trigger stimulation of CD8+ cells.…”