Recurrent Respiratory Papillomatosis: A Report of two cases and review of literature

Abstract

Abstract Background: Recurrent Respiratory Papillomatosis (RRP) is a non-cancerous tumour of the upper airway caused by the
human papilloma virus, presenting as “wart-like” growth, which could be anywhere from the nose to the lungs commonly in the larynx.

Design and Setting: Review of two cases at the National Hospital Abuja (NHA).

Objectives: To highlight the challenges in the management of RRP.

Subjects: Two patients diagnosed with RRP were referred to the paediatric respiratory clinic between 2009 and 2012. Case one is
four year old female who presented with persistent hoarseness of voice, breathing difficulty and noisy breathing of one year duration. She was born at term by spontaneous vertex delivery to a mother who had vaginal warty lesion excised during pregnancy. A neck X-ray showed opacities around the laryngeal region with total obliteration of air column with histological confirmation of squamous papilloma. She had eight excision surgeries within a two years period with treatment with oral acyclovir, interferon, and methotrexate and tracheotomy tube in situ. Case two, a six year old female presented with persistent
hoarseness of voice that progressed to loss of voice, noisy and difficulty in breathing, snoring and frequent arousal from sleep of 1½ years. Histology was diagnostic of laryngeal Papillomatosis and she had two excisions surgeries and treatment with oral acyclovir and tracheotomy tube in place.

Conclusion: RRP though a slow growing tumour, presently has no definitive cure. Excision surgeries provide temporal relief and antiviral agents adjuvant therapies. Prevention with vaccination is desirable.

Keyword: Recurrent respiratory Papillomatosis, Human papilloma virus.