AN UNUSAL CASE OF CONDYLOMA ACUMINATA WITH MAGGOTS BY  Prof. Renuka Mohanty  Dr. S.Mahapatro  Dr. S.S.Kar  Dr. J.P.Mahapatra HI-TECH MEDICAL COLLEGE & HOSPITAL, BHUBANESWAR

CASE HISTORY 2 Yrs Male Child. Wt – 8 kg, SES - Poor C/C Difficulty in defecation since six months. Passage of maggot since 15 days. Mass over perianal region since last 6 months.

HISTORY Antenatal, Natal and Postnatal history - Normal Developmental History - Normal No family history of such attack He was treated with Homeopathic medicine, but in vain.

O/E Wt – 08Kg, Ht – 80Cm. Mild degree of anemia, HR – 100/m,RR – 30 / m, BP – 80/60 mm Hg CVS, P/A, Chest, CNS - Normal LOCAL EXAMINATION OF PERIANAL AREA  Cauli flower like mass (5 x 4.5 x 2.5 cm 3 )  Nonfriable, moist, fleshy, almost covering the anal opening.  Super infected with Maggots.  No bleeding from the mass.

INVESTIGATIONS Hb - 8 gm% DC, TLC, URINE, STOOL - Normal Blood for VDRL – Negative

PATHOLOGY EXAMINATION (BIOPSY ) Consistent with Candyloma Acuminata ( Mucus membrane wart) Acanthotic epidermis with pappillomatosis, hyperkeratosis & parakertosis. Dermal capillary vessels are thrombosed. There were koilocytes.

TREATMENT :- Initially treated with turpentine oil and IV antibiotics (Ampiclox) After 5 days the whole mass was surgically removed. FOLLOW UP :- On 3m /6m /9m follow up there was no reoccurrence of the lesion

DISCUSSION  Epidermal manifestation attributed to the epidermotropic HPV  HPV type 6 and 11 (90 % of CA)  HPV in genital area are mostly sexually transmitted. In paediatric age group > 3yr sexual abuse must be considered. In < 3 yr – by direct manual contact, indirectly by fomites or vertical transmission

HPV  Common warts to squamous cell carcinoma of skin.  70 subtypes are recognized.

Perineum around the anus, vagina and urethra, intravaginal and intra-anal area,glans penis, saft, corona, labia. Rarely at conjunctive, gingiva and nasal mucosa, tounge, lip. SITES

 May resolve spontaneously.  Salicylic acid  Podifilox 0.5% solution  Formaldehyde  Belomycin  Retinoids  Interferon α, β (Low effectiveness, high toxicity)  Cimetidine Cry therapy Laser therapy Loop electro surgical excision

Weekly application of 25% podophyllin on tincture of benzoin. Immiquimod (5% cream ) - Thrice Weekly Resistance cases - Weekly freezing with liquid nitrogen or by carbon dioxide lasar.

With all forms of therapy – 50% reoccur. So periodic follow up is required.