Zusammenfassung
Die juvenile Larynxpapillomatose ist eine seltene, durch humane Papillomaviren (HPV)
verursachte Erkrankung. Bei aggressiven Verlaufsformen sind bleibende Stimm- und Atemstörungen
durch eine Vielzahl notwendiger Papillomabtragungen bisher kaum zu vermeiden. Um die
Rezidivrate bei schwerer Verlaufsform zu senken, werden heute die Immunstimulation
mit Interferon alpha oder die lokale Applikation von Cidofovir empfohlen. Auch Mumps-Impfungen
und eine fotodynamische Therapie werden angewendet. Im vorliegenden Fall wurde versucht,
durch Immunisierung mit dem quadrivalenten HPV-Spaltimpfstoff Gardasil® den Krankheitsverlauf
bei einem zweijährigen Jungen, der seit 9 Monaten erkrankt war, positiv zu beeinflussen.
Durch chromogene In-situ-Hybridisierung und Polymerase-Kettenreaktion (PCR) an Läsionsgewebe
war eine simultane HPV-Infektion durch HPV-Typ 6 und 11 nachgewiesen. Nach der dritten
Impfung stabilisierte sich der Krankheitsverlauf. In den bisher zehn Monaten nach
der letzten Impfung war kein erneuter Progress erkennbar. Aufgrund des geringen Risikos
dieser Form der adjuvanten Behandlung halten wir eine multizentrische Studie zur Klärung
der Wirksamkeit für gerechtfertigt, auch wenn eine vollständige Viruselimination mit
diesem Impfstoff nicht wahrscheinlich ist.
Juvenile Laryngeal Papillomatosis – Immunisation with the Polyvalent Vaccine Gardasil®
Juvenile laryngeal papillomatosis is a rare condition caused by human papilloma virus
(HPV). In cases with rapid recurrences permanent impairments of voice and breathing
are almost inevitable due to the frequent need of debulking surgeries. Efforts to
lower the recurrence rate comprise the adjuvant use of interferon alpha, local cidofovir,
photodynamic therapy or mumps vaccination.
In the present case we tried to positively influence the aggressive course of disease
in a two year old boy by immunisation with the quadrivalent HPV vaccine Gardasil®.
Chromogenic in-situ hybridisation analysis and polymerase chain reaction (PCR) of
lesion tissue showed simultaneous infection with the HPV-Types 6 and 11. After the
third immunisation the disease became stable. No further surgery was necessary for
the last ten months.
The risk profile of this adjuvant treatment is low. We think it worth to initiate
a multicentre trial to prove a benefit of this treatment even if no complete virus
elimination can be achieved.
Schlüsselwörter
Larynx - HPV - Papillomavirus - Gardasil - Larynxpapillomatose - Fallbericht
Key words
larynx - papillomavirus - HPV - Gardasil - laryngeal papillomatosis - case report
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Dr. med. Gerhard Förster
Klinik für HNO-Heilkunde/Plastische Operationen
SRH Wald-Klinikum Gera
Straße des Friedens 122
07548 Gera
Email: gerhard.foerster@wkg.srh.de
