Age: 16.0
Sex: F
Vaccine: HPVX
Symptoms: Chemotherapy, Concomitant disease aggravated, Cough, Fatigue, Lung squamous cell carcinoma stage IV
Clinical narrative: This case was reported in a literature article and described the occurrence of concomitant disease aggravated in a 17-year-old female patient who received HPV vaccine. The patient's past medical history included papilloma excision (at the age of 4 and 10). Concurrent medical conditions included respiratory papillomatosis (diagnosed at the age of 1 year), lung nodule and lung cyst. Concomitant products included cidofovir and interferon. On an unknown date, the patient received HPV vaccine at an unknown dose. On an unknown date, 1 year after receiving HPV vaccine, the patient experienced concomitant disease aggravated (serious criteria hospitalization). The patient was treated with chemotherapy, nos. On an unknown date, the outcome of the concomitant disease aggravated was unknown. It was unknown if the reporter considered the concomitant disease aggravated to be related to HPV vaccine. Additional information received: This case was reported in a literature article and it described the occurrence of aggravation of concomitant disease in a 17-year-old female patient who had received unspecified human papillomavirus vaccines (manufacturer unknown) for treatment of the active disease. No information was available regarding her birth. Concurrent medical conditions included respiratory papillomatosis that had been diagnosed at the age of 1 year and that had required two bronchoscopic excisions of papillomas at the age of 4 and 10, laser surgical resection every three months since she was 10 to control the bulk of the disease within her hypopharynx and larynx, as well as intralesional treatment with cidofovir that was started when she was 10 and interferon therapy that was started when she was 13 (please note that the authors did not specify if these last 2 treatments were still ongoing at the time of the vaccination). A chest computed tomography scan performed at 11 years of age revealed typical pulmonary features of juvenile-onset recurrent respiratory papillomatosis, including small solid pulmonary nodules and multiple coalescent cystic structures in both lungs. When it was repeated at 14 years of age, it showed similar findings although some of the cystic lesions had mildly retracted and had with increased nodular components. No further information on the patient's family history was provided. On unspecified dates, at the age of 16, the patient received what the authors described a complete vaccination series of an unspecified human papillomavirus vaccine for treatment of the active disease -off-label-use- (dosages unknown; administration routes and sites unspecified; batch numbers not provided). On an unspecified date, when the patient was 17 years old and 1 year after completing the vaccination series, the patient presented with complaints of fatigue and a 40-pound weight loss over the previous 10 months. She also reported a chronic cough, but no new or acute respiratory symptoms different to her usual ones. She was diagnosed with squamous cell carcinoma (stage IV) that the authors believed to be a malignant degeneration of the juvenile-onset recurrent respiratory papillomatosis. The primary tumour was located on her right lower lobe and it had spread through her chest wall, affecting the posterior mediastinal area and the contralateral lung. She also presented an additional metastatic spread to her right kidney and mass effect on the posterior part of her heart. This case was considered as an aggravation of concomitant disease. This was a serious case as the patient required hospitalisation. A computed tomography examination of the chest showed a significant change from prior results and that was compatible with tumour/nodes/metastasis stage IV malignant disease. Surgical biopsy revealed invasive well-differentiated squamous cell carcinoma. Treatment consisted of chemotherapy but it was unsuccessful. At the time of reporting the outcome of the event was unresolved. According to the authors the disease had progressed despite the treatment and the patient was discharged to palliative home care two and a half months after being diagnosed with cancer. The authors did not comment on any causal relationship between the vaccine and the event. The authors concluded that "The recent introduction of the human papilloma virus vaccine is a promising tool in the prevention of disease transmission and progression, but more studies need to be performed to investigate its impact on juvenile-onset recurrent respiratory papillomatosis. Current literature hypothesizes that the human papilloma virus vaccine may decrease incidence of juvenile-onset recurrent respiratory papillomatosis within the upper airway and subsequent head and neck cancer. There has been no evidence that the human papilloma virus vaccine prevents malignant transformation in active cases of pulmonary juvenile-onset recurrent respiratory papillomatosis. At this time, there are no specific recommendations for use in treatment of active disease. Of note, our patient illustrated here completed the vaccination series at 16 years of age but did go on to develop malignant transformation of pulmonary disease a year later. Examination of the effect of such a vaccine on the spread of juvenile-onset recurrent respiratory papillomatosis to involve the lower airway and subsequent malignant transformation should be considered, with hopes of eradication in future generations".