title: Oral HPV infection and MHC class II deficiency (A study of two cases with atypical outcome).
abstract: BACKGROUND
  Major histocompatibility complex class II deficiency, also referred to as bare lymphocyte syndrome is a rare primary Immunodeficiency disorder characterized by a profondly deficient human leukocyte antigen class II expression and a lack of cellular and humoral immune responses to foreign antigens. Clinical manifestations include extreme susceptibility to viral, bacterial, and fungal infections. The infections begin in the first year of life and involve usually the respiratory system and the gastrointestinal tract. Severe malabsorption with failure to thrive ensues, often leading to death in early childhood. Bone marrow transplantation is the curative treatment.
  
  
  METHODS
  Here we report two cases with a late outcome MHC class II deficiency. They had a long term history of recurrent bronchopulmonary and gastrointestinal infections. Bone marrow transplantation could not be performed because no compatible donor had been identified. At the age of 12 years, they developed oral papillomatous lesions related to HPV (human papillomavirus). The diagnosis of HPV infection was done by histological examination. HPV typing performed on the tissue obtained at biopsy showed HPV type 6. The lesions were partially removed after two months of laser treatment.
  
  
  CONCLUSIONS
  Viral infections are common in patients with MHC class II and remain the main cause of death. Besides warts caused by HPV infection do not exhibit a propensity for malignant transformation; they can cause great psychosocial morbidity.
authors.affiliation: Centre National de Greffe de Moelle Osseuse, Service d'immuno-Hématologie Pédiatrique, Faculté de Médecine de Tunis 2, Rue Djebel Lakhdhar, 1006 Tunis, Tunisia. nawel.guirat@yahoo.fr.
authors.forename: Naouel
authors.initials: N
authors.lastname: Guirat-Dhouib
authors.forename: Yemen
authors.initials: Y
authors.lastname: Baccar
authors.forename: Imène Ben
authors.initials: IB
authors.lastname: Mustapha
authors.forename: Monia
authors.initials: M
authors.lastname: Ouederni
authors.forename: Sameh
authors.initials: S
authors.lastname: Chouaibi
authors.forename: Nadia
authors.initials: N
authors.lastname: El Fekih
authors.forename: Mohamed Ridha
authors.initials: MR
authors.lastname: Barbouche
authors.forename: Bassima
authors.initials: B
authors.lastname: Fezaa
authors.forename: Ridha
authors.initials: R
authors.lastname: Kouki
authors.forename: Slama
authors.initials: S
authors.lastname: Hmida
authors.forename: Fethi
authors.initials: F
authors.lastname: Mellouli
authors.forename: Mohamed
authors.initials: M
authors.lastname: Bejaoui