The conundrum of an accumulating acuminatum

Abstract

Patient: Male, 70 Final Diagnosis: Chronic condyloma acuminatum Symptoms: Dizziness • fatigue • generalized weakness • weight loss Medication: — Clinical Procedure: Colostomy Specialty: General and Internal Medicine Objective: Unusual clinical course Background: A 70-year-old African American man presented with fatigue, dizziness, generalized weakness, and considerable weight loss of over 20 pounds in 3 weeks. History-taking revealed he was positive for HIV, hepatitis C, and severe chronic condyloma acuminatum, which had been progressing for 16 years. Treatment and surgical inter-vention had been continuously postponed due to the patient’s long-standing history of heroin abuse. Case Report: Physical exam and diagnostics showed evidence of sepsis. He was hypotensive, with lactic acidosis and significant leucocytosis, and had acute-on-chronic kidney disease. Urinalysis was positive for nitrites and leukocyte esterase; therefore, broad-spectrum antibiotics were initiated. Additional sources of sepsis were considered due to persistent leucocytosis despite appropriate antibiotic coverage. An MRI of the pelvis was done to eval-uate for necrosis of fistulization from potential internal warts as a source of sepsis. The lesions extended from the inguinal areas bilaterally, covering the medial thighs, lower scrotal wall, and wall junction. It had infiltrat-ed the perineum and the entire rectal area, including the gluteal cleft and anus. The patient was consulted by colorectal surgery, urology, and infectious disease services. Conclusions: Surgical biopsies found that he had both low-and high-grade squamous intraepithelial neoplasia. There was no evidence of invasive carcinoma, which was a concern given his weight loss. Surgery devised a plan that in-cluded a diverting colostomy (allowing the infected anal area to heal), followed by resection of his giant con-dyloma, and re-anastomosing of the bowels to return him to a normal baseline anatomy. A favorable progno-sis was expected.