Giant condyloma acuminatum in a patient with HIV infection: a case report.

Giant condyloma acuminatum (GCA), also known as Buschke-Löwenstein tumor, is a rare tumor-like lesion associated with human papillomavirus (HPV) infection. Although it is histologically benign, it behaves in a locally aggressive manner. GCA most commonly involves the external genitalia, perianal region, perineum, and rectum. It occurs more frequently in immunocompromised individuals, particularly those with advanced or suboptimally controlled human immunodeficiency virus (HIV) infection. Here, we report a case of perianal GCA in an HIV-infected patient and discuss the diagnostic and therapeutic challenges encountered, with the aim of informing clinical management of this disease. We describe a 24-year-old man with a 7-year history of HIV infection who had suboptimal adherence to antiretroviral therapy (ART). Over the past 3 years, he developed a gradually enlarging perianal mass with intermittent bleeding and purulent discharge. Over a 6-month period, he presented with progressive fatigue and exertional dyspnea. Laboratory evaluation revealed severe anemia and hypoproteinemia. The diagnosis of GCA was established by histopathological examination of the perianal lesion, supported by imaging findings and clinical manifestations, and assessed for disease extent. He underwent wide local excision of the mass and received optimized antiretroviral therapy, culture-guided antimicrobial therapy, and supportive care. He experienced marked clinical improvement postoperatively. At 3-month follow-up, the wound had completely healed, anal sphincter function was preserved, and there was no evidence of recurrence. This case illustrates a rare but clinically significant manifestation of HPV-related disease in the context of HIV-associated immunosuppression. GCA should be considered in the differential diagnosis for HIV-positive patients presenting with extensive anogenital masses. Early histopathological confirmation and multidisciplinary management facilitate timely diagnosis and intervention.