Management of Adult Recurrent Respiratory Papillomatosis with Oral Acyclovir Following Micro Laryngeal Surgery: A Case Series
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.
KeywordsAdult recurrent respiratory papillomatosis (ARRP) Papillomatosis Acyclovir Human papilloma virus (HPV)
- 1.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 119:554–557PubMedCrossRefGoogle Scholar
- 3.Lee E, Katakami N, Sakamoto H et al (1986) A case of papillomatosis of larynx and trachea. Kikanshi 8:97–102Google Scholar
- 6.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):134–140Google Scholar