Focal epithelial hyperplasia by human papillomavirus (HPV)‐32 misdiagnosed as HPV‐16 and treated with combination of retinoids, imiquimod and quadrivalent HPV vaccine

Abstract

Focal epithelial hyperplasia (FEH) or Heck's disease is a rare, benign and asymptomatic mucosal proliferation associated with human papillomavirus (HPV) infection, mainly with genotypes 13 and 32. We report a florid case of FEH in an 11-year-old Haitian girl with systemic lupus erythematosus receiving immunosuppressive therapy. Cryotherapy was previously performed on numerous occasions with no results. We decided to prescribe a non-invasive and more comfortable treatment. A combination of topical retinoid and imiquimod cream was well tolerated and led to an important improvement. The evidence of infection by HPV-16 detected by polymerase chain reaction (PCR) technique, prompted us to prescribe the quadrivalent HPV vaccine (types 6, 11,16 and 18). Subsequent PCR sequencing with generic primers GP5-GP6 and further BLAST comparative analysis confirmed that genomic viral sequence in our case truly corresponded with HPV-32. This molecular misdiagnosis can be explained by the similarity between genomic sequences of both HPV-16 and -32 genotypes. At the 1-year follow up, we observed total clinical improvement and no recurrences of the disease. Complete healing in this case may correspond to a potential action of topical retinoid, imiquimod and the cross-protection mechanism of the quadrivalent HPV vaccine.

Unusual presentation of a disseminated oral HPV infection after combined antiretroviral therapy initiation

“…Focal epithelial hyperplasia and oral condyloma acuminata have similar clinical and histopathological characteristics. Both are caused by low-risk HPVs, with condyloma being more often associated with HPV-6 and HPV-11, although several other types (including HPV-32 and more rarely high-risk HPVs) have been described in these lesions 4,8,9 .…”

“…Based on the clinical aspect of the lesions, histopathological findings and detection of HPV-32, it was possible to diagnose the presence of epithelial proliferation due to HPV infection. The unusual clinical presentation raised discussion on the lesions, suggesting that it might be a case of either focal epithelial hyperplasia (FEH), a lesion strongly associated with HPV-32 4 ,or condyloma acuminata aggravated by the syndrome of immune reconstitution (SIR).…”

“…Cytodestructive and excisional methods or their combination have been the most common choices for a low-cost treatment of lesions caused by HPV 4,5 . The first option of treatment for HPV oral lesions is almost always their surgical removal.…”

Exuberant oral lesions in an immunocompromised patient

“…The HPV subtypes most commonly detected in Heck disease are 13 and 32. 3 D. White sponge nevus-Incorrect. Rare genodermatosis caused by mutations in the keratin 4 or 13 gene.…”

“…C. Complete HPV vaccine schedule-Correct. Considering the oncogenic nature of HPV, patients should be instructed on the use of preventive methods and a HPV vaccine schedule 3. D. Self-inoculation-Incorrect.…”