Resolution of Novel Human Papillomavirus– induced Warts after HPV

Human papillomavirus (HPV) XS2 was isolated from warts on an immunosuppressed patient. After HPV vac-cination, the warts resolved. HPVXS2 was also found in warts and normal skin of HIV-positive patients and rarely in HIV-negative controls. Further studies should elucidate the mechanisms that lead to wart clearance. Human papillomaviruses (HPVs), small, double-strand-ed DNA viruses with a circular genome of ≈8,000 bp, are assigned to different genera and species on the basis of their major capsid protein gene (L1) nucleotide sequence, which reflects their tropism (cutaneous or mucosal) and potential to induce tumors. Most HPVs belong to genera alpha (e.g., genital and wart-associated types), beta, or gamma (cutaneous types) (1). HPV infections are common, and the prevalence of cutaneous viral warts is 3%–5 % in children (2). Warts, benign HPV-induced lesions, usually regress spontaneously within several months. Immunode-ficiency predisposes to persistent HPV infections and the development of generalized verrucosis (2,3). We report the remission of cutaneous warts of pro-longed duration in an immunosuppressed patient after HPV vaccination. The study was performed according to the declaration of Helsinki; written informed consent was obtained from the patient. The Patient In 1979, a 41-year-old, White woman received a di-agnosis of B cell chronic lymphocytic leukemia and was treated with chlorambucil and prednisolone, followed by radiation therapy and splenectomy, resulting in a durable, complete remission of the leukemia. In October 2002, breast cancer was detected in the patient; the breast was surgically removed, and lymph node dissection was per-formed. Six cycles of chemotherapy were administered during November 2002–March 2003. In February 2010, after a 12-year history of slowly progressing cutaneous warts, the patient sought medical care for numerous, flat, erythematous warts that were coalescing into large plaques on her forearms, backs of hands, and fingers (on-line Technical Appendix Figure, panel A, wwwnc.cdc. gov/EID/article/20/1/13-0999-Techapp1.pdf). Immuno-phenotyping revealed a markedly decreased CD4/CD