title: Focal epithelial hyperplasia by human papillomavirus (HPV)-32 misdiagnosed as HPV-16 and treated with combination of retinoids, imiquimod and quadrivalent HPV vaccine.
abstract: Focal epithelial hyperplasia (FEH) or Heck's disease is a rare, benign and asymptomatic mucosal proliferation associated with human papillomavirus (HPV) infection, mainly with genotypes 13 and 32. We report a florid case of FEH in an 11-year-old Haitian girl with systemic lupus erythematosus receiving immunosuppressive therapy. Cryotherapy was previously performed on numerous occasions with no results. We decided to prescribe a non-invasive and more comfortable treatment. A combination of topical retinoid and imiquimod cream was well tolerated and led to an important improvement. The evidence of infection by HPV-16 detected by polymerase chain reaction (PCR) technique, prompted us to prescribe the quadrivalent HPV vaccine (types 6, 11,16 and 18). Subsequent PCR sequencing with generic primers GP5-GP6 and further BLAST comparative analysis confirmed that genomic viral sequence in our case truly corresponded with HPV-32. This molecular misdiagnosis can be explained by the similarity between genomic sequences of both HPV-16 and -32 genotypes. At the 1-year follow up, we observed total clinical improvement and no recurrences of the disease. Complete healing in this case may correspond to a potential action of topical retinoid, imiquimod and the cross-protection mechanism of the quadrivalent HPV vaccine.
authors.affiliation: Department of Dermatology, Hospital Universitari Vall d'Hebron, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Franco
authors.initials: F
authors.lastname: Gemigniani
authors.affiliation: Department of Pathology, Hospital Universitari Vall d'Hebron, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Hernández-Losa
authors.affiliation: Department of Pathology, Hospital Universitari Vall d'Hebron, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Berta
authors.initials: B
authors.lastname: Ferrer
authors.affiliation: Department of Dermatology, Hospital Universitari Vall d'Hebron, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: García-Patos
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage; D000634:Aminoquinolines / Q000008:administration & dosage; D002648:Child; D003131:Combined Modality Therapy; D003951:Diagnostic Errors; D005260:Female; D017573:Focal Epithelial Hyperplasia / Q000175:diagnosis* / Q000628:therapy / Q000821:virology; D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18 / Q000008:administration & dosage; D052162:Human papillomavirus 16 / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D000077271:Imiquimod; D027383:Papillomaviridae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000628:therapy* / Q000821:virology; D012176:Retinoids / Q000008:administration & dosage
chemical_list: D000276:Adjuvants, Immunologic; D000634:Aminoquinolines; D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18; D012176:Retinoids; D000077271:Imiquimod
keywords: focal epithelial hyperplasia; human papillomavirus; imiquimod; polymerase chain reaction; quadrivalent human papillomavirus vaccine