Man died from HPV in UHW, doctor issues serious warning
The man died at University Hospital Waterford (UHW).
A man in his early 40's died from complications stemming from Human Papilloma Virus (HPV) at University Hospital Waterford (UHW).
The man presented at UHW with anal warts, described as “large, extremely tender, ulcerating, malodorous”, covering his buttocks, perineum and upper thigh.
He told doctors that he had had the warts for roughly two years.
Doctors diagnosed the warts, medically referred to as condylomata acuminata, as deriving from a HPV infection of benign subtype.
The doctors cited evidence of benign HPV initiating a growth process that can develop into a malignant phenotype due to chronic epithelial irritation.
They cautioned in the report: "There is risk of malignant transformation in benign HPV infections."
The case prompted the doctor to issue a warning on the need for HPV screening for men in Ireland.
HPV is a family of very common viruses that are passed on during skin-to-skin contact, that can affect men and women.
When undiagnosed, HPV damages the DNA cells in the body and can lead to cancer.
HPV is strongly linked to cervical cancer, and cancers of the mouth and throat, and penis.
According to the National Cancer Registry Ireland (NCRI): "HPV-associated cancers account for almost 3% of all invasive cancers excluding non-melanoma skin cancer (NMSC) in Ireland, but account for 7% of such cancers in young adults aged 20-49 years."
In recent years, HPV vaccines have been rolled out across Irish schools and have been proven to reduce the risk of invasive cancer.
The HPV vaccine currently used in Ireland is called Gardasil 9.
660,000 doses of Gardasil have been administered and over 220,000 girls have been fully vaccinated against HPV.
The case report in the Irish Medical Journal (IMJ) described the man as "a smoker with a 30-pack year history and significant alcohol consumption, with 140 units a week".
He had a BMI of 16 and had lost 25kg in the previous two years.
The man told doctors that he was not sexually active and denied any sexual involvement with men.
Upon medical inspection, doctors discovered a large grouping of warts: "There was a large, extremely tender, ulcerating, malodorous condylomatous mass covering the majority of his perianal and bilateral buttock area, including his perineum and medical thigh area."
According to the report: "He was significantly anaemic; with a haemoglobin of three g/dl. Blood-borne virus and syphilis screen were negative.
"PCR swabs for varicella and herpes zoster were negative. Radiological workup revealed an extensive locally invasive tumor with no distant metastases."
The patient underwent a procedure which revealed a high level of AIN (Anal intraepithelial neoplasia).
Doctors opted against a surgical intervention as the extent of the disease was deemed "unresectable".
The procedure, known as a loop ileostomy, was to allow the patient to pass bodily waste through a stoma.
After the procedure, the man "absconded" from treatment and did not return for six months.
When he did return, doctors noted a significant deterioration in his health.
The report stated: "He was too frail at this point for systemic therapy. He declined rapidly and received specialized palliative care. He died in two months."
The author of the report noted that early intervention, screening and monitoring could have helped the patient recover from his illness.
She wrote: "This case emphasizes the importance of advocating for patients to engage with healthcare services. It also demonstrates that there is still a lack of screening programmes in Ireland for HPV in men, particularly outside of high-risk population.
"When multiple factors compound (lack of patient engagement, subclini lack of AIN screening programme), it can lead to serious consequences in HPV infection, i.e. death in this case."
There is no HPV screening programme for men currently operating in Ireland.
