Citation: Mehtani N, Thong G, Yaghchi CA, Sandhu G. A classical case of recurrent respiratory papillomatosis in an adult. J Clin Images Med Case Rep. 2022; 3(1): 1542.

Clinical image description

A 22-year-old female university student presented with hoarseness of voice for a few months. She had difficulty to project her voice and underwent initial voice assessment and stroboscopy, which mild–moderate dysphonia characterised by breathy husky quality with mild roughness on Grade of hoarseness; Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale.

She did not complain on any difficulties swallowing or breathing. She has a background of mild Asthma for which she uses inhalers but otherwise is generally well in herself. She is a non-smoker and is fully vaccinated.

On examination, she underwent flexible nasoendoscopy which was showed some lesions bilaterally over the vocal cords. Following this she underwent a microlaryngoscopy and biopsy of the lesions and histology was diagnostic of Laryngeal papillomatosis. She was treated with laser therapy and cold steel resection of the lesions along with a course of Gardasil vaccination. Since then, she’s had further two operations to help reduce the disease burden with laser, microdebridement and steroid injection. Her symptoms have improved after serial intralesional steroid injections with mild residual disease and continues to be followed up [1,2].

Recurrent Respiratory Papillomatosis (RRP) is a chronic disease of the respiratory tract that occurs in both children and adults. It is caused by the Human Papillomavirus (HPV), low-risk HPV6 and HPV11, and its aggressiveness varies among patients.

References

1. Ivancic R, Iqbal H, de Silva B, Pan Q, Matrka L. Current and future management of recurrent respiratory papillomatosis. Laryngoscope Investig Otolaryngol. 2018; 3: 22-34.
2. Al Yaghchi, Chadwan. Benign Laryngeal Lesions. 2019. 10.1201/9781003000518.