BI04 Successful treatment of recalcitrant warts in a patient with chronic lymphocytic leukaemia with intralesional human papillomavirus 9-valent vaccine

Abstract

A 62-year-old man was referred to the dermatology clinic in 2024 with a 6-year history of persistent, symptomatic warts involving both nasal cavities. Over the preceding year, the lesions had been surgically excised on two occasions, with rapid recurrence following each procedure. Numerous over-the-counter wart treatments had be trialled without benefit. His medical history was significant for chronic lymphocytic leukaemia, diagnosed in 2011 and clinically stable without treatment. On examination, multiple verrucous lesions were present bilaterally along the mucocutaneous junctions of the nasal cavities. A comprehensive full-skin examination was otherwise unremarkable. Treatments prescribed included topical imiquimod 5% applied four times weekly for 6 weeks, multiple sessions of cryotherapy, oral cimetidine 400 mg and zinc supplementation 15 mg twice daily, all of which resulted in minimal to no improvement. Given the recalcitrant nature of the lesions, intralesional human papillomavirus (HPV) vaccination was initiated following an intradepartmental discussion within dermatology, supported by published evidence of its utility. The patient received intralesional HPV 9-valent vaccine administered at 2-week intervals, with a total of six treatments given. At each session, 0.1 mL of vaccine was injected directly into the warts within the nasal cavity. The procedure was well tolerated, with no adverse events noted during or after the procedure. Clinical improvement was observed within 1 month of the initial injection, with continued regression of lesions throughout the treatment course and no new wart formation during therapy. At his 3-month follow-up, the nasal mucosa and surrounding skin remained clear. This case highlights the potential role of intralesional HPV vaccination as an effective therapeutic option for recalcitrant mucocutaneous warts in immunocompromised patients.