Key Clinical Message
In patients with psoriasis, reactivation of latent HPV may be unrelated
to recent immunomodulators. This requires further research of possible
mechanisms and public awareness.
A 35-year-old man presented with
multiple incidental white and erythematous, cauliflower-like, filiform,
painless warts in the perianal and bilateral inguinal regions (Figure
1). Several of the warts had hyperpigmented tips. He noticed the warts
approximately 3 months previously, and they recently increased in
number. The patient had a history of plaque psoriasis and inverse
psoriasis since the age of 16 years and had scaly, erythematous plaques
with sharp margins over his scalp, face, neck, trunk, gluteal cleft,
upper limbs, and lower limbs (Figure 2). His palms and the soles of his
feet did not have any warts. The Koebner phenomenon and Auspitz sign
were present. He had received topical corticosteroids, topical
calcipotriene, tar, systemic methotrexate, and ultraviolet (UV)
irradiation, all of which were ineffective and were discontinued 3 years
prior to the present complaint. He denied any history of unprotected
sexual exposure or anal sexual contact. The patient had not received an
HPV vaccine. He had no oral ulcers, arthralgia, nor dysuria. Upon
physical examination, there was no fever, warts over the penis, or
scrotum, as well as no urethral discharge or palpable lymphadenopathy.
There were no intra-anal lesions. Syphilis screening tests (Venereal
Disease Research Laboratory and Treponema pallidum particle
agglutination tests) and an anti-human immunodeficiency virus screening
test (enzyme-linked immunosorbent assay) were non-reactive. We performed
tumor excision and electrocauterization for the perianal lesions.
Histopathological findings were compatible with condyloma acuminata
(Figure 3). Clinical follow-up showed no tumor recurrence, but the
typical Koebner phenomenon was observed in the excisional sites 2 weeks
postoperatively.