[Dissecting pseudomembranous celiocytic vaginitis caused by HPV in a HIV positive patient]

The Authors describe a case of dessicant pseudomembranous vaginitis caused by HPV types 6, 11, 16 and 18 in a 44-year-old HIV seropositive woman. A material mixed with blood, simulating a spontaneous abortion because of its quantity and consistency, was ejected vaginally. A spontaneous abortion was excluded on the basis of a pelvic echographic exam and on the beta-HCG plasma level. Histologic examination of the ejected material demonstrated an epithelium of the vaginal mucosa in which was found a marked and extensive koilocytosis of intermedial and parabasal layers. The vaginal mucosa in this patient differed from the commonly observed koilocytosis and condylomatous proliferation histological aspects seen in vaginal HPV lesions. In the context of the epithelium, by means of confluence of voluminous koilocytotic elements, pseudocystic lacunar spaces of varying dimensions definable as "koilocytotic pseudocysts" were observed. Within the vaginal epithelium, along a line of reduced resistance, a massive and extensive dessication resulted in a laminar detachment of the overlying epithelial stratum. Regarding the association between HIV and HPV infection, it is known that seropositive patients with immunodeficiencies are at high risk of infection by a variety of pathogens and, among these, different types of HPV. The viral association in this case undoubtedly promoted the extension and seriousness of the lesion and its exceptional complication.