Perianal Epidermodysplasia Verruciformis Associated With Human Papillomavirus 5 After a Renal Transplant

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A 66-year-old African American woman presented for a 1-year history of multiple perianal lesions. The woman had undergone a renal transplant 7 years ago for renal failure due to hypertension. Her current medications included the immune suppressants, oral prednisone, and mycophenolic acid. She has no family or personal history of skin cancer. The lesions previously were clinically suspected to be low-grade squamous intraepithelial lesions by the referring clinician and had been treated with cryotherapy, imiquimod, sinecatechins ointment, and candida antigen injections, which had shown temporary improvement.
Upon examination, she was noted to have multiple flat-topped papules, which coalesced into plaques on her perineum and perianal skin simulating verruca plana (see Figure 1). A biopsy of one lesion was performed, and this revealed a low-level verruciform lesion with superficial keratinocytes with abundant light gray cytoplasm surrounding slightly hyperchromatic and irregular nuclei (see Figure 2). This was interpreted as human papillomavirus (HPV) viral cytopathic effect most suggestive of epidermodysplasia verruciformis (EDV). There was no significant expansion of the immature basaloid layer or suprabasal mitotic figures to suggest high-grade squamous intraepithelial lesion. The material was sent for HPV polymerase chain reaction determination, which revealed HPV 5 as previously described.1 A retrospective review of the lesions performed by the referring clinician also revealed similar histopathological findings including EDV-like changes. The lesions responded completely with curettage and healed well. Examination for similar lesions on the remainder of the skin revealed no similar lesions or evidence of HPV infection. Anoscopy revealed no abnormalities, and there were no abnormal cevical pap smears.

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