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Anthony A. Gaspari, MD; Alicia D. Zalka, MD; Deborah Payne, PhD; Marilyn Menegus, PhD; Leslie A. Bunce, MD; Camille N. Abboud, MD; Stephen K. Tyring, MD, PhD

Arch Dermatol. 1997;133(4):491-496.

Abstract
Background
We describe a patient with generalized verrucosis secondary to human papillomavirus (HPV) type 2 infection and a primary immunodeficiency and cyclic neutropenia. Treatment, which was well tolerated, included granulocyte-macrophage colony-stimulating factor and interferon gamma (IFN-). In vitro assays to assess responses of T lymphocytes to mitogens (ie, proliferation assay and IFN- enzyme-linked immunosorbent assay) were performed. In situ hybridization and polymerase chain reaction were used to detect HPV DNA in skin biopsy specimens.

Observations
The T lymphocytes of the patient showed a significant (P<.05, unpaired Student t test) defect in IFN- production (the basis for initiating IFN- therapy). The response to immunotherapy was confirmed by using molecular methods. Six months after the completion of immunotherapy, HPV DNA was undetectable in skin samples from clinically regressed warts (according to the results of in situ hybridization and polymerase chain reaction).

Conclusions
Our patient had treatment-resistant generalized verrucosis for 13 years. Treatment with granulocyte-macrophage colony-stimulating factor and IFN- may have reconstituted an immune response against HPV, resulting in the dramatic regression of her widespread warts.

Arch Dermatol. 1997;133:491-496

Author Affiliations
From the Department of Dermatology (Drs Gaspari and Zalka), the Cancer Center and Strong Children's Research Center (Dr Gaspari), the Department of Microbiology (Dr Menegus) and the Division of Hematology, Department of Medicine (Drs Bunce and Abboud), University of Rochester School of Medicine and Dentistry, Rochester, NY; and the Departments of Microbiology/Immunology (Drs Payne and Tyring) and Dermatology (Dr Tyring), University of Texas Medical Branch at Galveston.

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