title: Focal Epithelial Hyperplasia in Adult Patients With HIV Infection: Clearance With Topical Imiquimod.
abstract: Case 1A 41-year-old man with human immunodeficiency virus (HIV) 1 diagnosed 16 years prior to his consultation was referred for an 8-month history of multiple painless lumps in his mouth. He had A2 status (CD4 cell count of 273 cells/mm3and viral load of 43,000 copies/L) and was taking treatment with lamivudine/zidovudine (combivir) and efavirenz. Physical examination showed multiple small mucosal-colored and lobulated papulonodules located in the palate and lower gingiva and a whitish verrucous plaque on the lower labial mucosa (Figure 1a). The lesions were diagnosed clinically as focal epithelial hyperplasia (FEH) and further confirmed by classical histopathological findings (Figure 1b). He had previously received unspecified treatment; thus, topical 5% imiquimod cream was initiated every night. Mild erosion and ulceration developed in the upper labial mucosa, which were managed with lubrication (petrolatum ointment). After 2 weeks, all of the small lesions disappeared and the largest plaque resolved 1 week later (Figure 1c). A small residual mass in the area of biopsy, suggesting a scar, remained on the lower lip. The area was removed surgically and corresponded to fibrosis histologically, with no evidence of human papillomavirus (HPV) infection. CD4 cell count (694 cells/mm3) and viral load (<40 copies/L) did not show remarkable changes after imiquimod administration. No serious side effects were observed and the patient has remained free of disease after 1 year of follow-up.
authors.affiliation: Departments of Dermatology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico; silvia_mendezflores@live.com.mx.
authors.forename: Silvia
authors.initials: S
authors.lastname: Méndez-Flores
authors.affiliation: Departments of Dermatology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico.
authors.forename: Lilly
authors.initials: L
authors.lastname: Esquivel-Pedraza
authors.affiliation: Departments of Dermatology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico.
authors.forename: Amparo
authors.initials: A
authors.lastname: Hernández-Salazar
authors.affiliation: Departments of Dermatology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico.
authors.forename: Yann
authors.initials: Y
authors.lastname: Charli-Joseph
authors.affiliation: Pathology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico.
authors.forename: Marcela
authors.initials: M
authors.lastname: Saeb-Lima
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage*; D000328:Adult; D000634:Aminoquinolines / Q000008:administration & dosage*; D019380:Anti-HIV Agents / Q000627:therapeutic use; D017573:Focal Epithelial Hyperplasia / Q000188:drug therapy* / Q000209:etiology*; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D006801:Humans; D000077271:Imiquimod; D008297:Male; D030361:Papillomavirus Infections; D019562:Viral Load; D015215:Zidovudine / Q000627:therapeutic use
chemical_list: D000276:Adjuvants, Immunologic; D000634:Aminoquinolines; D019380:Anti-HIV Agents; D015215:Zidovudine; D000077271:Imiquimod