Laryngeal papillomatosis: recurrence after 33-year remission

After repeated laryngeal papilloma excisions, a 4-year-old Caucasian male became symptom-free. Benign squamous papilloma recurred in the larynx and trachea at age 37 after a gunshot wound, prolonged nasogastric intubation, several laparotomies, endotracheal anesthesias, and massive weight loss. This case and others in the literature suggest that current therapy produces prolonged remission, not "cure." Its course reinforces accumulating evidence for the existence of human papilloma viruses (HPV) whose DNA apparently becomes incorporated into host laryngeal cell DNA, supporting an hypothesis that HPV remains in normal-appearing epithelium adjacent to papilloma. Like herpes zoster varicella virus, HPV may lie dormant until reactivated by host immunosuppression, trauma, malnutrition or sepsis, features also present in the patient described. Repeated intubation probably injured and destroyed cells, releasing viral material. Papilloma patients in remission probably should be warned of factors, including intubation for elective surgery, which could induce recurrence.