Background and Importance Genital warts caused by human papillomavirus (HPV) in condylomatosis often show a variable response to recommended therapies, especially in immunocompromised patients. New alternatives to improve their approach are needed.

Aim and Objectives To describe the effectiveness, safety, and preparation of cidofovir intralesional injections (ILI) for the treatment of HPV condylomatosis in an immunocompromised patient.

Material and Methods We describe the case of a 33-year-old woman with a giant perianal condylomata accuminata (affecting the clitoris, labia majora and minora, vagina, anal canal and both nalgae). She was initially immunocompromised due to a renal transplant (no renal graft at the starting of cidofovir) and a late-detected common variable immunodeficiency. Condylomatosis precipitated several episodes of bacterial cellulitis. The patient had been previously treated with liquid nitrogen, podophyllotoxin, imiquimod 5%, sinecatechins and 5-fluorouracil, obtaining no response.

Off label treatment with monthly cidofovir ILIs for cytoreductive purposes was proposed and approved. Response to cidofovir ILIs was assessed by reduction in both the number and size of anogenital warts.

Results Cidofovir ILIs were prepared by diluting a vial of cidofovir 375 mg in 60 ml of 0.9% sodium chloride, obtaining a final concentration of 6.25 mg/ml. Of these 60 ml, 5 syringes of 12 ml were loaded (75 mg of cidofovir in each one), which have a stability of 5 months refrigerated (2–8°C), according previous studies.

Intralesional cidofovir treatment started in February 2022. After three drug administrations, a significant improvement in lesions was described by a reduction in both their volume and extension. A bad odor of superficial exudate was also reported, which was solved with first polymyxin and later fusidic acid, both administered topically, twice a day. The patient presented good tolerance to injections, only requiring local anesthesia with lidocaine for pain.

Conclusion and Relevance This is the first case of use of this formulation of cidofovir ILIs in a patient with anogenital condylomatosis and immune deficiency. Previously, it was used in other manifestations of HPV infection. The formulation also proved to be stable, well-tolerated, and easy to prepare. Therefore, this therapy may be considered a reasonable option for the treatment of HVP condylomatosis when other treatments seem ineffective.

Conflict of Interest No conflict of interest