Extensive development of flat warts as a cutaneous manifestation of immune reconstitution syndrome

Cutaneous manifestations of immune recovery in response to highly active antiretroviral therapy may account for up to 54% to 78% of the clinical presentations of the immune reconstitution syndrome (IRS). Genital herpes, varicella-zoster virus infection, genital warts, and molluscum contagiosum represent the majority of these cutaneous manifestations. Inflammation of preexisting cutaneous warts in response to effective antiretroviral therapy has rarely been described. We report the case of sudden extensive development of cutaneous warts, specifically verruca plana confirmed by skin biopsy, observed following antiretroviral therapy-associated immune reconstitution in a patient without a history of warts. The possibility of cutaneous IRS after commencement of antiretroviral therapy should be considered in a patient with unusual skin manifestations.