Abstract
To demonstrate the role of oral acyclovir in monthly regimes after microdebrider assisted excision in 3 patients with adult recurrent respiratory papillomatosis (ARRP). Three patients with ARRP who presented to a tertiary referral hospital in stridor were initially treated with a tracheostomy in order to secure airway. On further evaluation by videolaryngoscopy extensive bilateral laryngeal papillomatosis was noted with history of similar conditions in the past for which they were repeatedly operated. They were admitted and underwent Microlaryngeal surgery and laryngeal microdebrider assisted surgery under general anesthesia. Post operatively a course of oral acyclovir at 800 mg/5 times/day for 5 days was administered. On repeat assessment with videolaryngoscopy at monthly intervals a complete remission of the disease was noted with no residual disease at the end of 1 year in 2 cases. One case had a recurrence. Renal parameters were monitored periodically. It may be concluded that the action of anti viral drugs at regular intervals in addition to a short course of oral steroids lead to rapid recovery and prevented latent virus activation within the laryngo tracheal system hence maintaining long term improvement. This can avoid multiple laryngeal surgeries, repeated respiratory emergencies and risk for malignant transformation in the future thereby reducing morbidity and effect on quality of life.
References
Smith EM, Pignatari SSN, Gray SD, Haugen TH, Turek LP (1993) Human papillomavirus infection in papillomas and nondiseased respiratory sites of patients with recurrent respiratory papillomatosis using the polymerase chain reaction. Arch Otolaryngol Head Neck Surg 119:554–557
Kramer SS, Wehunt WD, Stocker JT, Kashima H (1985) Pulmonary manifestations of juvenile laryngotracheal papillomatosis. AJR Am J Roentgenol 144:687–694
Lee E, Katakami N, Sakamoto H et al (1986) A case of papillomatosis of larynx and trachea. Kikanshi 8:97–102
Steinbrook R (2006) The potential of human papillomavirus vaccines. N Engl J Med 354:1109–1112
Szeps M, Dahlgren L, Aaltonen LM, Öhd J (2005) Human papillomavirus, viral load and proliferation rate in recurrent respiratory papillomatosis in response to alpha interferon treatment. J Gen Virol 86:1695–1702
Deunas L, Alcantud V, Alvarez F (1997) Use of interferon-alpha in laryngeal papillomatosis: eight years of the Cuban national programme. J Laryngol Otol 1997(111):134–140
Kimberlin DW (2004) Current status of antiviral therapy for juvenile-onset recurrent respiratory papillomatosis. Antiviral Res 63:141–151
Drennan JM, Douglas AC (1965) Solitary papilloma of a bronchus. J Clin Pathol 18:401–402
Singer DB, Greenberg SD, Harrison GM (1966) Papillomatosis of the lung. Am Rev Respir Dis 94:777–783
Steinberg BM, Topp W, Schneider PS, Abramson AL (1983) Laryngeal papillomavirus infection during clinical remission. N Engl J Med 308:1261–1264
Abramson AL, Nouri M, Mullooly V, Fisch G, Steinberg BM (2004) Latent human papillomavirus infection is comparable in the larynx and trachea. J Med Virol 72:473–477
Broker TR, Jin G, Croom-Rivers A et al (2001) Viral latency: the papillomavirus model. Dev Biol (Basel). 106:443–451
Bonagura VR, Hatam L, DeVoti J, Zeng F, Steinberg BM (1999) Recurrent respiratory papillomatosis: altered CD8(+) T-cell subsets and TH1/TH2 cytokine imbalance. Clin Immunol. 93:302–311
DeVoti JA, Steinberg BM, Rosenthal DW et al (2004) Failure of gamma interferon but not interleukin-10 expression in response to human papillomavirus type 11 E6 protein in respiratory papillomatosis. Clin Diagn Lab Immunol 11:538–547
Shikowitz MJ, Abramson AL, Steinberg BM, Voti JD (2005) Clinical trial of photodynamic therapy with meso-tetra (Hydroxyphenyl) chlorin for respiratory papillomatosis. Arch Otolaryngol Head Neck Surg 131:99–105
Snoeck R, Wellens W, Desloovere C, Van Ranst M, Naesens L, De Clercq E, Feenstra L (1998) Treatment of severe laryngeal papillomatosis with intralesional injections of cidofovir [(S)-1- (3-hydroxy-2-phosphonylmethoxypropyl)cytosine]. J Med Virol 54:219–225
Dallimore NS (1985) Squamous bronchial carcinoma arising in a case of multiple juvenile papillomatosis. Thorax 40:797–798
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Chaturvedi, J., Sreenivas, V., Hemanth, V. et al. Management of Adult Recurrent Respiratory Papillomatosis with Oral Acyclovir Following Micro Laryngeal Surgery: A Case Series. Indian J Otolaryngol Head Neck Surg 66 (Suppl 1), 359–363 (2014). https://doi.org/10.1007/s12070-011-0456-7
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DOI: https://doi.org/10.1007/s12070-011-0456-7