Management of Adult Recurrent Respiratory Papillomatosis with Oral Acyclovir Following Micro Laryngeal Surgery: A Case Series

Abstract

To demonstrate the role of oral acyclovir in monthly regimes after microdebrider assisted excision in 3 patients with adult recurrent respiratory papillomatosis (ARRP). Three patients with ARRP who presented to a tertiary referral hospital in stridor were initially treated with a tracheostomy in order to secure airway. On further evaluation by videolaryngoscopy extensive bilateral laryngeal papillomatosis was noted with history of similar conditions in the past for which they were repeatedly operated. They were admitted and underwent Microlaryngeal surgery and laryngeal microdebrider assisted surgery under general anesthesia. Post operatively a course of oral acyclovir at 800 mg/5 times/day for 5 days was administered. On repeat assessment with videolaryngoscopy at monthly intervals a complete remission of the disease was noted with no residual disease at the end of 1 year in 2 cases. One case had a recurrence. Renal parameters were monitored periodically. It may be concluded that the action of anti viral drugs at regular intervals in addition to a short course of oral steroids lead to rapid recovery and prevented latent virus activation within the laryngo tracheal system hence maintaining long term improvement. This can avoid multiple laryngeal surgeries, repeated respiratory emergencies and risk for malignant transformation in the future thereby reducing morbidity and effect on quality of life.

An updated review of the epidemiological factors associated with recurrent respiratory papillomatosis

“…Evidence from this study suggests that acyclovir has both a safe side effect profile and may be used in combination with surgery as an adjuvant treatment for aggressive RRP 48 . Though robust clinical trials are limited, additional reports endorse these findings and suggest the need for future studies 49 …”

Laryngotracheal Recurrent Papillomatosis: A Case Study and Survey of Surgical and Systemic Management

“…Chaturvedi et al reports concluded that the action of anti-viral drugs at regular intervals in addition to a short course term of oral steroids led to rapid recovery and prevented latent virus activation within the laryngotracheal system, maintaining long-term improvement. 20 Figure 2. Chest X-ray showing no cavitary or consolidated lesions.…”

Recurrent Respiratory Papillomatosis: An Update

“…49 It targets herpes simplex virus and Epstein-Barr virus which can be concurrent and coinfection of HPV in RRP. 50 The mechanism of action of acyclovir in RRP is not clear, but it is thought to inhibit DNA viral replication. Acyclovir is used systemically, with dosing in literature ranging from 500-600 mg daily for 5-6 months.…”