日本性感染症学会誌 Journal of Japanese Society for Sexually Transmitted Infections

A 50-year-old woman with a history of systemic lupus erythematosus (SLE) was referred to our clinic because of papules in the anogenital area. These papules started to develop 4 years ago and gradually increased in number. From the skin biopsy, Bowenoid papulosis (BP) was diagnosed. At the same time, cervical lesion was found, and cervical intraepithelial neoplasia (CIN) 2 was diagnosed. Using polymerase chain reaction (PCR), human papilloma-virus (HPV) types 18, 52, and 56 were detected in five sample papules, which were identical to that observed in samples obtained from the patient’s cervix. It was believed that HPV infection caused both BP and cervical lesions. For SLE, oral prednisolone 35 mg was administered daily. Although cryotherapy and topical imiquimod were initiated, clinical effects were limited. Papules were atomized using a CO₂ laser when the prednisolone intake was decreased to 11 mg per day. Topical imiquimod therapy was continued, but during follow-up examination, it was observed that papules began to appear again. After 4 months, cervical examination revealed CIN3; hence, conization was conducted. Because the sample indicated cervical cancer, total hysterectomy was performed. After surgery, refractory BP showed rapid recovery. It is suggested that SLE and continued intake of immunosuppressive prednisolone partially caused the BP to be resistant to therapy and induced the progression from CIN2 to squamous cell carcinoma.