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

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 Crohns 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