Author(s)
Michelle K. White, MD
Andrew R. Scott, MD
Mark A. Vecchiotti, MD
Affiliation(s)
Tufts Medical Center; Tufts Children's Hospital;
Abstract:
Introduction: Recurrent respiratory papillomatosis (RRP) is the most common benign laryngeal neoplasm in children. Surgery is mainstay of treatment with adjuvant therapy indicated in more severe cases. HPV vaccination has been shown to be an effective adjuvant therapy for adult-onset RRP, however safety and efficacy in the pediatric population has only been described in case reports.
Methods: Case report and review of the literature. Informed consent was obtained from the study subject.
Case Report: This is the case of a 2-year-old female from Haiti with juvenile-onset RRP (JoRRP) and tracheostomy presenting in extremis with aphonia and dyspnea, found to have extensive obstructive glottic and tracheal papillomatosis. Initial treatment included surgical debulking and Gardasil-9 HPV vaccination. Over the next 20 months, she made return trips from Haiti and underwent four minor surgical procedures and received a second dose of Gardasil-9. As early as four months post-op, she is phonating and endoscopy revealed patent glottic and tracheal airways with no evidence of residual papilloma.
Discussion: Despite its off-label use, HPV vaccination contributed to improving this patient’s prognosis from palliative at presentation to no evidence of papilloma currently. While other adjuvant therapy options for JoRRP are often costly and require general anesthesia, vaccine administration is low-cost and does not require the operating room.
Conclusion: HPV vaccination is an effective and practical treatment option for children with JoRRP, particularly in children with limited access to healthcare both in the United States and the developing world.