The Buschke-Löwenstein tumor (BLT) is a rare and aggressive form of condyloma acuminatum, associated with persistent infection by human papillomavirus (HPV), particularly types 6 and 11, and may coexist with oncogenic types such as 16 and 18. It is characterized by exophytic verrucous lesions, slow growth with locally invasive behavior, high risk of recurrence, and potential for malignant transformation, especially in immunosuppressed individuals. We report the case of a 25-year-old male patient, living with HIV acquired via vertical transmission, who had been lost to follow-up for eight years and returned to treatment irregularly, evolving with advanced immunosuppression (CD4 59), maintaining detectable viral load, suggesting poor medication adherence, virologic failure, or even undocumented resistance. Since 2023, he has presented with large verrucous lesions on the genital area and pubic region, with progressive growth, active bleeding, foul odor, and intense pain, refractory to multiple topical and destructive therapies – cryotherapy, electrocauterization, 5-fluorouracil, Imiquimod®, and HPV vaccination. He was evaluated by urology and dermatology and diagnosed with penile Buschke-Löwenstein tumor, without histological criteria of malignancy (penile biopsy performed), and imaging studies were deemed unnecessary. As treatment, partial penectomy was proposed, but refused by the patient, and a conservative approach was chosen (podophyllin 25%, control of secondary bacterial infection, and periodic compressive dressings). BLT represents, in addition to a viral disease of exuberant presentation, a clinical marker of immunological failure associated with HIV and a therapeutic challenge due to the histological presentation without dysplasia, aggressiveness of the growth pattern, refractoriness to treatment, recurrent secondary infections, and clinical characteristics of the lesion that pose an imminent risk of progression to invasive squamous cell carcinoma. This case highlights the importance of maintaining HIV viral suppression and immunologic restoration as central elements in the prevention and management of coinfections associated with HIV, and underscores the need for alternative, less mutilating therapeutic strategies, especially in young patients with psychosocial resistance to proposed surgical interventions.
Kaiabi et al. (Sun,) studied this question.