Acharya R, Bush R, Johns F, Upadhyay K. Efficacy and safety of local candida immunotherapy in recalcitrant warts in pediatric kidney transplantation: A case report. World J Transplant 2023; 13(4): 201-207 [PMID: 37388391 DOI: 10.5500/wjt.v13.i4.201]
Corresponding Author of This Article
Kiran Upadhyay, MD, Associate Professor, Doctor, Department of Pediatric Nephrology, University of Florida, 1600 SW Archer Road, Gainesville, FL 32610, United States. kupadhyay@ufl.edu
Research Domain of This Article
Transplantation
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Ratna Acharya, Department of Pediatrics, University of Florida, Gainesville, FL 32610, United States
Rachel Bush, Felicia Johns, Kiran Upadhyay, Department of Pediatric Nephrology, University of Florida, Gainesville, FL 32610, United States
Author contributions: All authors contributed to the study conception and design, writing; Acharya R, Bush R, and Johns F were involved in the acquisition of the clinical data, analysis, and interpretation; Upadhyay K was involved in the critical revision.
Informed consent statement: Informed consent was obtained from the parent of the patient for publication of the information.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE checklist, and the manuscript was prepared and revised according to the CARE checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kiran Upadhyay, MD, Associate Professor, Doctor, Department of Pediatric Nephrology, University of Florida, 1600 SW Archer Road, Gainesville, FL 32610, United States. kupadhyay@ufl.edu
Received: February 25, 2023 Peer-review started: February 25, 2023 First decision: March 15, 2023 Revised: March 21, 2023 Accepted: April 4, 2023 Article in press: April 4, 2023 Published online: June 18, 2023 Processing time: 110 Days and 17.9 Hours
Abstract
BACKGROUND
Warts are common in recipients of kidney transplantation (KT). Resistant warts which are not amenable to conventional therapies may lead to significant morbidity. Limited data exists on safety and efficacy of local immunotherapy among immunocompromised KT recipients.
CASE SUMMARY
We report a seven-year-old child who presented with recalcitrant plantar periungual warts in the early KT period. Immunosuppression consisted of tacrolimus, mycophenolate and steroid. Due to failure of conventional anti-wart therapies, he was treated with two sessions of intralesional (IL) candida immunotherapy along with liquid nitrogen cryotherapy leading to complete resolution of the warts. Interestingly, de novo BK viremia was seen about three weeks following the last candida immunotherapy. This required reduction of immunosuppression and other anti-BK viral therapies. Allograft function remained stable but there were donor specific antibodies detected. There also was elevated level of plasma donor derived cell-free DNA. A pneumocystis jirovecii pneumonia occurred ten months following completion of immunotherapy that was successfully treated with trimethoprim-sulfamethoxazole. During this ten-month follow-up period, there have been no recurrence of warts, and transplant kidney function has remained stable.
CONCLUSION
Stimulation of cell-mediated immunity against the human papilloma virus induced by the IL candida immunotherapy is thought to be a cause for wart resolution. With this therapy, whether it is necessary to augment the immunosuppression to prevent rejection is unclear as that may come with a risk of infectious complications. Larger, prospective studies in pediatric KT recipients are needed to explore these important issues.
Core Tip: Warts are common after pediatric kidney transplantation. Given immunosuppressed status, most children are unable to clear the warts with conventional anti-wart therapies. Local immunotherapy has emerged as an excellent treatment modality for treatment of resistant warts following kidney transplantation. However, the safety of such agents needs careful consideration with longitudinal studies. Here, we studied the efficacy and safety of local candida immunotherapy in an immunocompromised child with kidney transplantation and recalcitrant plantar warts.
