Abstract
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Background: Common warts (Verruca vulgaris) are benign proliferative lesions of the skin and mucosa caused by human papillomavirus (HPV) infection. In patients living with HIV, these lesions tend to persist and are significantly associated with a higher number of lesions, more extensive involvement, and progressively recalcitrant. Various treatment modalities have been proposed and can be challenging with variable results; no single therapy has been proven to be universally effective. Triple combination therapy with available modalities such as destructive, immunomodulator antiviral drug, and immunization represents a promising approach to achieving improved long-term clinical outcomes.
Observation: A 36-year-old man presented with recalcitrant warts on his right hand, both arms, buttocks, left leg, right chest, and left side of the stomach two years ago in 2024. Initially, only one wart appeared on his left arm, and over time increased and spread to other parts of his body. He had previously received treatment with a prescription cream, but no improvement was found. A history of common warts and condyloma acuminata occurred twice before in 2023 and had previously undergone electrodesiccation and curettage, but reappeared again after several months. He was diagnosed with HIV in 2017 and has been taking anti-retroviral treatment ever since. History of sexual partnership with the same and opposite sex. Physical examination showed multiple verrucous nodules, papules, and skin colored keratoses, varying in size. Histopathology image showed several koilocytosis, verrucous lesions, and acanthosis with a partial inward slope. Electrodesiccation and curettage were performed, with application of 90% TCA spot treatment to the lesion area immediately after the procedure. Post-procedure, the patient received methisoprinol 1g three times daily and three doses of quadrivalent HPV vaccination. One and a half-year follow-up in 2026, the outcome showed good results, with only small warts reappeared on the left leg, and no other new lesions. Months after the evaluation, has not found any new warts until this paper was submitted.
Key message: Triple combination therapy as a protection to prevent recurrence yield long term effectiveness in recalcitrant HIV patient.
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