title: Successful treatment of a generalized human papillomavirus infection with granulocyte-macrophage colony-stimulating factor and interferon gamma immunotherapy in a patient with a primary immunodeficiency and cyclic neutropenia.
abstract: BACKGROUND
  We describe a patient with generalized verrucosis secondary to human papillomavirus (HPV) type 2 infection and a primary immunodeficiency and cyclic neutropenia. Treatment, which was well tolerated, included granulocyte-macrophage colony-stimulating factor and interferon gamma (IFN-gamma). In vitro assays to assess responses of T lymphocytes to mitogens (ie, proliferation assay and IFN-gamma enzyme-linked immunosorbent assay) were performed. In situ hybridization and polymerase chain reaction were used to detect HPV DNA in skin biopsy specimens.
  
  
  METHODS
  The T lymphocytes of the patient showed a significant (P < .05, unpaired Student t test) defect in IFN-gamma production (the basis for initiating IFN-gamma therapy). The response to immunotherapy was confirmed by using molecular methods. Six months after the completion of immunotherapy, HPV DNA was undetectable in skin samples from clinically regressed warts (according to the results of in situ hybridization and polymerase chain reaction).
  
  
  CONCLUSIONS
  Our patient had treatment-resistant generalized verrucosis for 13 years. Treatment with granulocyte-macrophage colony-stimulating factor and IFN-gamma may have reconstituted an immune response against HPV, resulting in the dramatic regression of her widespread warts.
authors.affiliation: Department of Dermatology, University of Rochester School of Medicine and Dentistry, NY, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Gaspari
authors.forename: A D
authors.initials: AD
authors.lastname: Zalka
authors.forename: D
authors.initials: D
authors.lastname: Payne
authors.forename: M
authors.initials: M
authors.lastname: Menegus
authors.forename: L A
authors.initials: LA
authors.lastname: Bunce
authors.forename: C N
authors.initials: CN
authors.lastname: Abboud
authors.forename: S K
authors.initials: SK
authors.lastname: Tyring
mesh_terms: D000293:Adolescent; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D016867:Immunocompromised Host; D007371:Interferon-gamma / Q000627:therapeutic use*; D009503:Neutropenia / Q000150:complications* / Q000276:immunology; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000150:complications / Q000276:immunology / Q000628:therapy*; D012074:Remission Induction; D014412:Tumor Virus Infections / Q000150:complications / Q000276:immunology / Q000628:therapy*; D014860:Warts / Q000150:complications / Q000276:immunology / Q000628:therapy*
chemical_list: D007371:Interferon-gamma; D016178:Granulocyte-Macrophage Colony-Stimulating Factor