title: Human papillomavirus reactivation following treatment of genital graft-versus-host disease.
abstract: Vaginal chronic graft-versus-host disease (cGVHD) is a common complication of stem cell transplantation. Human papillomavirus (HPV) disease can reactivate after transplantation, presumably because of immune factors affecting systemic immunity, such as waning antibody titers, impaired T- and B-lymphocyte responses, and the use of immunosuppressive therapies. However, a relationship between the use of local immunosuppressive agents and HPV reactivation and spread has not been previously described, to our knowledge. A 30-year-old woman, 2 years post transplant receiving systemic cyclosporine for cGVHD, was treated with vaginal dilators, topical corticosteroids, and estrogen for vaginal cGVHD. Colposcopy and biopsy for abnormal cytology revealed condylomatous cervicitis. Over the next 4 months, while continuing dilator therapy, linear verrucous lesions developed in the vagina and vulva, and were successfully treated with laser therapy. Use of local immunosuppression and dilators for genital GVHD can enhance spread of HPV infection. Integration of HPV screening and treatment into the care of women with genital cGVHD and development of strategies to manage both conditions simultaneously are warranted.
authors.affiliation: Epsom and St Helier University Hospitals NHS Trust, London, UK.
authors.forename: T
authors.initials: T
authors.lastname: Sri
authors.forename: M A
authors.initials: MA
authors.lastname: Merideth
authors.forename: T Klepac
authors.initials: TK
authors.lastname: Pulanic
authors.forename: R
authors.initials: R
authors.lastname: Childs
authors.forename: P
authors.initials: P
authors.lastname: Stratton
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D027383:Papillomaviridae / Q000502:physiology*; D030361:Papillomavirus Infections / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D002575:Uterine Cervicitis / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D014623:Vaginal Diseases / Q000188:drug therapy* / Q000276:immunology; D014775:Virus Activation
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D016572:Cyclosporine
keywords: genital GVHD; graft-versus-host disease; human papillomavirus; immunosuppression; stem cell transplantation