Inhaled cidofovir as an adjuvant therapy for recurrent respiratory papillomatosis

Area of Science:

• Pediatric Otolaryngology
• Viral Infections
• Respiratory Diseases

Background:

• Recurrent respiratory papillomatosis (RRP) is a rare, chronic disease caused by human papillomavirus (HPV).
• RRP can lead to significant airway obstruction and morbidity, particularly in infants.
• Conventional treatments include surgical debridement and various medical therapies, often with limited success in severe cases.

Observation:

• A 4-month-old infant with a progressively worsening airway obstruction due to extensive glottic papillomas presented with respiratory distress.
• Despite multiple microdebridements, intralesional cidofovir, and systemic interferon-alpha, the infant's condition deteriorated, requiring prolonged hospitalization.
• Conventional treatments failed to control the disseminated papillomatous disease.

Findings:

• Inhaled cidofovir therapy (40 mg daily, 12 days on/2 days off) was initiated as a last resort.
• Within 6 weeks, inhaled cidofovir led to substantial improvement in the papillomatous disease burden.
• The patient's condition significantly improved, with a reduction in the Derkay score from 40 to 23.

Implications:

• Inhaled cidofovir may represent a novel and effective therapeutic option for severe, treatment-refractory recurrent respiratory papillomatosis in pediatric patients.
• This approach warrants further investigation to establish its long-term efficacy and safety profile.
• The findings suggest a potential paradigm shift in managing aggressive RRP cases unresponsive to standard treatments.