Recalcitrant hyperkeratotic verrucae in a renal transplant recipient clearing with cessation of immunosuppression

Maor, Danit; Brennand, Sarah; Goh, Michelle; Chong, Alvin H

doi:10.1016/j.jdcr.2017.09.025

Cited by 6 publications

(3 citation statements)

References 10 publications

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“…In most HPV infections in immunocompetent individuals, the cellular and cytotoxic immunity provided by T cells and natural killer cells are sufficient to control the warts[ 18 ]; however, in immunocompromised patients, due to lack of cell-mediated immunity, the proliferation of virus occurs causing warts, sometimes in unusual locations such as bladder[ 19 , 20 ]. Indeed, a few studies have reported clearance of the warts with reduction or cessation of immunosuppression only in KT recipients[ 21 , 22 ]. Conversion to another anti-rejection agent may be useful as well.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of local candida immunotherapy in recalcitrant warts in pediatric kidney transplantation: A case report

Acharya¹,

Bush²,

Johns³

et al. 2023

World J Transplant

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BACKGROUND Warts are common in recipients of kidney transplantation (KT). Resistant warts which are not amenable to conventional therapies may lead to significant mor bidity. Limited data exists on safety and efficacy of local immunotherapy among immunocompromised KT recipients. CASE SUMMARY We report a seven-year-old child who presented with recalcitrant plantar per iungual warts in the early KT period. Immunosuppression consisted of tacrolimus, mycophenolate and steroid. Due to failure of conventional anti-wart therapies, he was treated with two sessions of intralesional (IL) candida immunotherapy along with liquid nitrogen cryotherapy leading to complete resolution of the warts. Interestingly, de novo BK viremia was seen about three weeks following the last candida immunotherapy. This required reduction of immu nosuppression and other anti-BK viral therapies. Allograft function remained stable but there were donor specific antibodies detected. There also was elevated level of plasma donor derived cell-free DNA. A pneumocystis jirovecii pneumonia occurred ten months following completion of immunotherapy that was successfully treated with trimethoprim-sulfamethoxazole. During this ten-month follow-up period, there have been no recurrence of warts, and transplant kidney function has remained stable. CONCLUSION Stimulation of cell-mediated immunity against the human papilloma virus induced by the IL candida immunotherapy is thought to be a cause for wart resolution. With this therapy, whether it is necessary to augment the immunosuppression to prevent rejection is unclear as that may come with a risk of infectious complications. Larger, prospective studies in pediatric KT recipients are needed to explore these important issues.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of local candida immunotherapy in recalcitrant warts in pediatric kidney transplantation: A case report

Acharya¹,

Bush²,

Johns³

et al. 2023

World J Transplant

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“…The known spontaneous remission of HPV‐induced warts, which is attributed to cell‐bound mechanisms, underscores the role of the immune system, including an increase in Th1 cytokines and infiltration of T cells (CD4 + , CD8 + ) around the diseased tissue . It has been shown that immunosuppressed patients experience resolution of treatment‐refractory warts once their immune status has improved .…”

Section: Introductionmentioning

confidence: 99%

Extragenital cutaneous warts – clinical presentation, diagnosis and treatment

Abeck¹,

Tetsch²,

Lüftl³

et al. 2019

J Deutsche Derma Gesell

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Summary Extragenital cutaneous warts are benign epidermal tumors caused by human papillomaviruses (HPVs) and a frequent reason for patients to consult a dermatologist. Depending on wart type and site involved, the clinical presentation is highly varied. Given that warts represent a self‐limiting condition, a wait‐and‐see approach may be justified. However, treatment is always indicated if the lesions become painful or give rise to psychological discomfort. Factors to be considered in this context include subjective disease burden, patient age, site affected, as well as the number and duration of lesions. Destructive treatment methods involve chemical or physical removal of diseased tissue. Nondestructive methods consist of antimitotic and antiviral agents aimed at inhibiting viral proliferation in keratinocytes. Some of the various immunotherapies available not only have localized but also systemic effects and are thus able to induce remission of warts located at any distance from the injection site. Especially patients with warts at multiple sites benefit from this form of treatment. Intralesional immunotherapy using the mumps‐measles‐rubella (MMR) vaccine is a particularly promising option for the treatment of recalcitrant warts in adult patients. For children, on the other hand, HPV vaccination is a novel and promising approach, even though it has not been approved for the treatment of cutaneous warts. At present, there is no universally effective treatment available. Moreover, many frequently employed therapies are currently not supported by conclusive clinical trials.

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“…Dazu gehört beispielsweise eine Vermehrung von Th1‐Zytokinen in Kombination mit der Infiltration von T‐Zellen (CD4 + , CD8 + ) um das Warzengewebe . Eine Abheilung therapierefraktärer Warzen bei immunsupprimierten Patienten nach Verbesserung ihres Immunstatus ist ausreichend belegt .…”

Section: Introductionunclassified

Extragenitale kutane Warzen – Klinik, Diagnose und Therapie

Abeck¹,

Tetsch²,

Lüftl³

et al. 2019

J Deutsche Derma Gesell

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Zusammenfassung Extragenitale Warzen sind durch humane Papillomviren (HPV) ausgelöste gutartige Tumoren der Epidermis, die typ‐ und lokalisationsabhängig sehr unterschiedliche klinische Manifestationsformen ausbilden und ein häufiger Konsultationsgrund sind. In der Regel sind sie selbstlimitierend, so dass ein Abwarten gerechtfertigt ist. Schmerzen sie jedoch oder belasten sie psychisch, besteht immer die Indikation zur Behandlung, wobei der individuelle Leidensdruck, das Alter des Betroffenen, die Warzenlokalisation, die Zahl der Läsionen und die Bestehensdauer berücksichtigt werden müssen. Destruktive Verfahren tragen entweder chemisch oder physikalisch das Warzengewebe ab. Antimitotische und antivirale Wirkstoffe verhindern nichtdestruktiv die Vermehrung infizierter Keratinozyten beziehungsweise der Viren in den Keratinozyten. Verschiedene Immuntherapien wirken örtlich begrenzt oder systemisch. Letzteres hat den Vorteil, dass auch weit vom Injektionsort entfernte Warzen abheilen. Aus diesem Grund ist diese Form der Immuntherapie vor allem bei Patienten mit Warzen in mehreren Lokalisationen zu favorisieren. Bei Therapieresistenz im Erwachsenenalter ist vor allem die intraläsionale Immuntherapie mit dem Masern‐Mumps‐Röteln‐Impfstoff ein vielversprechender Therapieansatz, bei Kindern und Jugendlichen dagegen die Impfung gegen humane Papillomviren zur Krebsvorsorge, auch wenn diese Impfung bislang nicht zur Behandlung von Warzen zugelassen ist. Zurzeit kann kein Therapieverfahren eine vollständige Abheilung garantieren. Für zahlreiche, auch häufig eingesetzte Therapien fehlen derzeit aussagekräftige klinische Studien.

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Recalcitrant hyperkeratotic verrucae in a renal transplant recipient clearing with cessation of immunosuppression

Cited by 6 publications

References 10 publications

Efficacy and safety of local candida immunotherapy in recalcitrant warts in pediatric kidney transplantation: A case report

Efficacy and safety of local candida immunotherapy in recalcitrant warts in pediatric kidney transplantation: A case report

Extragenital cutaneous warts – clinical presentation, diagnosis and treatment

Extragenitale kutane Warzen – Klinik, Diagnose und Therapie

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