Vulvo-perianal giant condylomata accuminata (Buschke Lowenstein Tumor) in a HIV-infected woman: a case report

Abstract

Giant condylomata accuminata also known as Buschke Lowenstein Tumor (BLT) is a benign extensive cauliflower like lesion that is commonly found in the genital area. Its etiology is human pappiloma virus. It occurs more in men than women with a ratio of 2.7:1. Immunosuppresssion with HIV is the main risk factor but it has also been associated with pregnancy, diabetes, chronic steroid use and organ  transplants. It is debilitating with extensive psychosocial maladjustments and has 50% potential for  malignant transformation. The study was undertaken at Kenyatta National Hospital Gynecological ward. A 37 year old Para 2+0, HIV-infected woman on Highly Active Antiretroviral Therapy (HAART) for the past eight years, presented with a seven year history of progressive vulval growths and a five year history of per vaginal discharge and pruritus. The growths were insidious in onset and progressive but with no associated pain. The discharge was yellow, watery, copious and not foul smelling. There was no history of dyspareunia or post coital bleeding. She had been treated with various creams and antibiotics with no improvement. The physical examination revealed extensive cauliflower vulvo-vaginal and perianal warts with confluence in the mons pubis and labia majora  bilaterally. The lesions appeared flat and brownish- black, and of variable diameter ranging from 0.5cm to 3cm. The lesions were not friable and did not bleed upon touch. Due to the extensive nature of the lesions, a decision to undertake simple vulvectomy was made. The patient was consented for the surgery, wide excision was done with successful primary closure of wound site. Histopathology results confirmed giant condylomata acuminata, with no malignant changes noted and free margins. The wound healed by primary intention within one week of surgery. At one year follow up, the patient was still on HAART, no recurrence of the vulval lesions and a Pap smear cytology report was normal. She was advised on condom use, adherence to HAART and on the  importance of sustained follow up. We concluded that HIV-infected women on HAART are at risk for BLT, a severe disease associated with malignant transformation, vulvo-perineal examination should be scheduled into routine follow up for early diagnosis and treatment.