Giant condyloma with demise secondary to meningococcemia in an infant boy

Human papilloma virus (HPV) is the most common sexually transmitted disease among adults in the USA; however, the presence of HPV in infants is rare. Condyloma acuminata, a cutaneous, fungating lesion caused by HPV, has a generally mild course that often resolves spontaneously or can be managed both medically and surgically. Typical treatments for condyloma include imiquimoid cream, podofilox gel, podophyllin resin, cryotherapy, laser surgery, tangential shave excision, and electrocautery. Rapidly progressing condyloma acuminata followed by a fatal course of Neisseria meningitis in an infant is an extremely rare presentation that merits further investigation into possible immunologic etiology. A 7-month-old circumcised Caucasian boy presented with a rapidly progressing giant penile condyloma acuminatum. This is the youngest documented case of this type. Refractory to medical and surgical treatments, this otherwise apparently healthy child was referred to pediatric immunology. Normal complete blood count led to deferment, suggesting further medical and surgical treatment. Five days after such treatment, the baby presented with progressive systemic rash, fever and tachycardia. The patient died from meningococcemia. This case serves as a warning concerning the course of condyloma in infants. Immunologic investigation may be critically important in young patients refractory to designated treatments for condyloma.