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Perianal condylomata and HPV-negative ileostomal papillomatous lesion in Crohn’s disease during Infliximab therapy

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Author(s): K.H. Katsanos, D.K. Christodoulou, Marga K. Basioukas1, Mary Bai2, E.V. Tsianos

Journal: Annals of Gastroenterology
ISSN 1108-7471

Volume: 18;
Issue: 1;
Date: 2007;
Original page

ABSTRACT
All patients with inflammatory bowel disease (IBD) with peristoma and stoma disorders who receive immunomodulatory therapy must undergo a detailed clinical, histological and microbiological examination including detailed history for pre-existing skin diseases. A 34-year old woman with Crohn’s disease during Infliximab treatment presented with tender verrucous lesions in the perianal area and a small verrucous lesion involving the ileostoma. Perianal lesions were enlarged and had a condylomatous appearance, and had become painful. At the same time, a small grayish-white papillomatous plaque on the upper circumference of the ileostoma, with a sharp outline but with no downward extension into the ileum, was noticed. Light microscopic analysis of the stoma lesion demonstrated only signs of mild chronic inflammation but no definite koilocytosis. In addition, immunohistochemical analysis for HPV was negative. Cryotherapy of perianal lesions was performed successfully while Infliximab infusions were interrupted. The patient was on regular follow-up and was receiving azathioprine and low doses of steroids. In all IBD cases with long-term immunomodulatory drug use, clinical follow-up is mandatory as long term toxicity and carcinogenecity of these new biological agents still remain under investigation. Key words: human papillomavirus (HPV), Crohn, inflammatory bowel disease, Infliximab, Remicade, anti-TNFa
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