[CIS PIDD] [cis-pidd] recalcitrant warts in PLE s/p Fontan

[Daniel Conway]

It can leave in areas of confluent warts, large "divots" in the skin to the dermis.  Also, the lesions become painful quickly and ache.  

That is all I I have seen though.  

Sincerely,
Daniel H. Conway, MD
Director, Dorothy Mann Center for Pediatric and Adolescent HIV
Chief, Section of Immunology
Assistant Professor of Pediatrics
St. Christopher's Hospital for Children
Drexel University College of Medicine

> On Mar 25, 2015, at 10:21 PM, Richard Wasserman <drrichwasserman at gmail.com> wrote:
> 
> If he has not been vaccinated with HPV vaccine, I would administer it. I don't fully understand it but I have heard that it can be helpful and I have had a positive personal experience (N=1).
> Richard Wasserman
> Dallas
> 
>> On Wed, Mar 25, 2015 at 9:17 PM, Perez, Elena Elizabeth <e.perez13 at med.miami.edu> wrote:
>> 
>> 
>> Dear colleagues,
>> 
>> I met a 16yo male patient last week with PLE s/p Fontan (followed at CHOP), who does not really get sick with recurrent infections but has had a chronic problem with recalcitrant warts all over his hands and fingers (very impressive physical exam).
>> 
>> Traditional therapies have not worked per dermatology. Local dermatologists are looking into using intralesional bleomycin and laser therapy or imiquimod. From what I read the bleomycin treatment can be pretty effective but painful and not without side effects (Dobson 2014 and Pollack 2002).
>> 
>> I'm sure this topic has been covered before, so I apologize if too much "repeat"...
>> 
>> In any case, wondering what the collective experience is in our immunodeficiency patients with intralesional bleomycin and laser vs. imiquimod, how effective, and whether any worrisome side effects have been noted in our populations...? or other alternatives?
>> 
>> [He has a h/o entocort use for PLE during a clinical study and then again later. He has adrenal issues followed by endocrine. Latest WBC, and ALC a 2 years ago was around 420. I don't yet have T cell function or antibody results].
>> 
>> (he is due for follow up at CHOP this summer but if I can help in the meantime, willing to do so)...
>> 
>> Thanks,
>> Elena Perez
>> Univ of Miami
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> 
> 
> -- 
> Richard L. Wasserman, MD, PhD
> DallasAllergyImmunology
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