Systemic Cidofovir in Papillomatosis

An 8-year-old patient with severe recurrent respiratory papil-lomatosis and pulmonary spread was treated by systemic administration of cidofovir in association with laser treat-ment for tracheal lesions. Complete disappearance of the lesions in the pharynx and larynx and a signi®cant yet in-complete regression in the bronchi and lung parenchyma were observed without deleterious side effects. This is the ®rst case report of systemic use of cidofovir to treat recurrent respiratory papillomatosis. Since the ®rst description of laryngeal papillomatosis in 1871, it has been recognized as the most common benign neoplasm of the larynx and the most common tumor of the upper res-piratory tract in children [1]. In the United States, 1500 new cases are diagnosed every year. Now called recurrent respiratory papillomatosis (RRP), it has a tendency to relapse and is seen in both children and adults [2]. The incidence is highest before the age of 5 years. Histologically benign, it may be a serious clinical problem because of its location, resistance to therapy, recurrences, occasional spread into the lower respiratory tract, and malignant transformation into squamous cell carcinoma. RRP is caused mainly by the human papillomaviruses HPV-6 and HPV-11 [2]. The standard treatment is palliative removal of the papillomas by CO2 laser to allow for both airway and voice improvement [3]. Numerous other forms of medical and surgical treatment have been used with varying success [4, 5]. This report concerns an 8-year-old Chinese girl with RRP of the pharynx, larynx, trachea, and lungs. There is currently no established therapy for RRP with pulmonary spread. We treate