Large plantar wart caused by human papillomavirus-66 and resolution by topical cidofovir therapy☆,☆☆

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Abstract

Warts can be difficult to diagnose and to treat in the setting of human immunodeficiency virus (HIV) infection. A 37-year-old woman with a background of HIV presented with a large verrucous plaque involving her right foot. Human papillomavirus (HPV)-66 was identified in the lesional skin biopsy sample and in scrapings obtained from her cervix. The wart rapidly responded to topical cidofovir therapy. HPV-66 is a novel HPV type to be associated with verruca vulgaris. Topical cidofovir should be further investigated as an alternative treatment modality for verruca vulgaris. (J Am Acad Dermatol 2000;43:340-3)

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Case report

A 37-year-old woman, a native of Kenya who had positive test results for human immunodeficiency virus (HIV), presented to the Department of Dermatology in October 1997 with a large verrucous plaque involving her right heel and extending up the medial and lateral aspects of her foot (Fig 1).

. Large verrucous plaque involving right heel extends up lateral and medial aspects of foot.

When she first noticed this lesion in February 1997, it involved only the lateral aspect of her right foot; it

Discussion

The clinical differential diagnoses of this lesion (Fig 1) included viral wart, deep fungal infection, squamous cell carcinoma, or verrucous carcinoma. Bacterial and fungal cultures were negative, and the biopsy specimen showed minimal viral changes. However, the clinical impression of verruca was confirmed by detecting HPV-66 with the polymerase chain reaction (Fig 4).

. Polymerase chain reaction products amplified from patient samples using human papillomavirus (HPV) L1 primers. Sequencing of

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This supplement is made possible through an educational grant from Ortho Dermatological to the American Academy of Dermatology.

☆☆

Reprint requests: Mark D. P. Davis, MB, MRCPI, Department of Dermatology, Mayo Clinic, 200 First St SW, Rochester, MN 55905.

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