title: Mucosal bridge and pitting of the true vocal fold: an unusual complication of cidofovir injection.
abstract: We describe a unique complication of intralaryngeal cidofovir injection and present the case of a patient with recurrent respiratory papillomatosis in whom both a mucosal bridge and a pit of the true vocal fold developed after intralaryngeal cidofovir injection. A 40-year-old man presented with laryngeal papillomatosis 19 years after being treated with surgery and adjuvant radiotherapy for leiomyosarcoma of the cervical esophagus. The patient underwent 5 papillomatosis excisions combined with subepithelial injections of cidofovir to the bilateral true vocal folds at a concentration of 5 mg/mL without any complications. He subsequently received 2 higher-dose cidofovir treatments 6 weeks apart because of a poor response to the previous treatments. Two months later, there was evidence of a large mucosal bridge along the free edge of the right vocal fold and a deep pit in the lateral aspect of the same vocal fold. We conclude that repeated high-dose intralesional injection of cidofovir may result in significant morphological changes to the vocal fold, most likely due to mucosal injury.
authors.affiliation: University of Pittsburgh Voice Center, Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Li-Xing
authors.initials: LX
authors.lastname: Man
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Statham
authors.forename: Clark A
authors.initials: CA
authors.lastname: Rosen
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000077404:Cidofovir; D003596:Cytosine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D006801:Humans; D015552:Injections, Intralesional; D007822:Laryngeal Neoplasms / Q000188:drug therapy*; D008297:Male; D009092:Mucous Membrane / Q000473:pathology; D063065:Organophosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D010212:Papilloma / Q000188:drug therapy*; D014827:Vocal Cords / Q000473:pathology*
chemical_list: D000998:Antiviral Agents; D063065:Organophosphonates; D003596:Cytosine; D000077404:Cidofovir