Condyloma acuminata at urethral orifice complicated with hemophilia A.

Dear Editor,

Condyloma acuminata is a sexually transmitted disease caused by the infection by human papilloma virus. Its warts are papillary or cauliflower-like. This report focuses on a case of condyloma acuminata complicated with hemophilia A. To avoid bleeding and infection during the treatment, we made a dermoscopic diagnosis, and performed the treatment with PDT, with a good clinical efficacy. The report is as follows.

A 37-year-old male patient was referred from the Outpatient Department in August 2012. The patient suffered repeated knee joint hematoma, and was diagnosed with hemophilia A by another hospital 20 years ago. He was treated with coagulant factor VIII, cryoprecipitate and frozen plasma in the local hospital. In the past two weeks, the patient was found to have several cauliflower-like excrescences at the urethral orifice, which grew up rapidly and was positive in acetowhite test. HPV-DNA was found to be type 6. The blood test showed WBC 8.07*109/L, RBC 5.43*1012/L, Hb 95 g/L, HCT 33.6%, MCV 61.9 fl, MCH 17.5 pg, RDW-CV 21.7%, MCHC 283 g/L, PLT 303*109/L, PT 10.7S, APTT-SS 78.2S, APTT-R 2.74. Based on his clinical history, the patient was diagnosed with hemophilia A complicated with condyloma acuminata at internal and external urethral orifice (Figure 1A and 1B).

Figures 1

A. 37-year-old male patient found to have cauliflower-like warts at urethral orifice. B. Papillary wart was dermoscopic visible, with obvious vascular characteristics

Hemophilia A is a hereditary hemorrhagic disease that causes coagulation disorders due to the deficiency of coagulant factor VIII. The major symptom of hemophilia A is spontaneous bleeding or non-stop bleeding after a minor injury. Condyloma acuminata (or genital warts) are excrescences on skin caused by the infection with human papillomavirus (HPV), and normally occur at genital or anal areas. [1] Conventional methods to treat genital warts include laser ablation, electrocauterization, microwave, corrosive drugs and destructive therapies, which however can only remove visible warts, and may cause ulcer, bleeding, damage to surrounding normal tissues, pain, infection and scarring. To avoid bleeding, we adopted dermoscopic diagnosis to clearly show the papillary excrescences and vascular characteristics. Considering the physical condition of this patient, we decided to apply 5-Aminolevulinic Acid Photodynamic Therapy (PDT) to treat condyloma acuminata at his urethral orifice. In 5-Aminolevulinic Acid Photodynamic therapy, photosensitizer, which can be selectively concentrated in the condyloma acuminata lesions, is locally applied. When the condyloma acuminata lesion is irradiated with light of 635 nm wavelength, the photosensitizer can produce singlet oxygen, which can cause necrosis of the lesions and slight injury to normal mucosal tissues. [2-3] If the patient with hemophilia A was treated with invasive methods that can cause ulcer, bleeding, and damage to surrounding normal tissues, the urethral orifice would bleed during the treatment due to the deficiency of coagulant factor VIII, and his wound would be difficult to heal. Therefore, we applied 5-Aminolevulinic Acid Photodynamic Therapy to treat the condyloma acuminata at his urethral orifice, with no ulcer, bleeding, or infection observed during the treatment. During the 6-month follow-up examination, no recurrence or scar was found; the skin was smooth; and the condyloma acuminata lesion was totally removed. (Figure 2A and 2B).

Figures 2

A. The lesion was completely removed after treatment with PDT. B. The same condyloma acuminata lesion during photodynamic therapy.