A case of acquired epidermodysplasia verruciformis in a renal transplant recipient clearing with multimodal treatment including gardasil vaccination

Background: We describe a case of acquired Epidermodysplasia verruciformis (EV) occurring in a 50-year-old female patient with a renal transplant. She presented in July 2014 with erythematous, flat papules on her groin and legs. A skin biopsy confirmed the diagnosis of acquired EV. HPV PCR confirmed the presence of HPV 5 beta-papilloma virus.
Treatment: The patient was initially treated with varying combinations of topical Tretinoin 0.05%, oral Acitretin 10mg daily and topical Imiquimod 5% cream. In August 2015, the patient was prescribed Gardasil vaccination in addition to the other topical and systemic therapies. The vaccination was completed in February 2016, 6 months later.
Results: On examination in March 2016, we found that the lesions had flattened and become less erythematous clinically after Gardasil vaccination. A repeat PCR swab done in March 2016 for HPV was negative for viral PCR.
Discussion: This was the first case of acquired EV responding to multimodal therapy, including Gardasil vaccination. We were also able to demonstrate clearance of HPV beta-papilloma virus on PCR.

Dr. Danit Maor

Skin & Cancer Foundation Inc., Victoria, Australia

Dr Danit Maor completed a Bachelor of Medicine and a Bachelor of Surgery (MBBS) at the University of Western Australia. She is currently the Occupational Dermatology Research fellow at the Skin & Cancer Foundation, Inc. in Victoria.
Last year she was the Research and Education Fellow at the Skin & Cancer Foundation focussing on transplant dermatology, research and educational workshops on a variety of different dermatological skills and topics.
Danit is due to complete a Masters of Public Health and Tropical Medicine in December this year.