Published online November 1, 2006
PEDIATRICS Vol. 118 No. 5 November 2006, pp. 1925-1931 (doi:10.1542/peds.2006-1555)
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ARTICLE

Recurrent Respiratory Papillomatosis in Children: Masquerader of Common Respiratory Diseases

Michael C. Zacharisen, MD, FAAPa and Stephen F. Conley, MD, FAAPb

a Department of Pediatrics, Section of Allergy and Immunology
b Department of Otolaryngology and Communication Sciences, Division of Pediatric Otolaryngology, Medical College of Wisconsin, Milwaukee, Wisconsin

BACKGROUND. Recurrent respiratory papillomatosis in children is an uncommon but potentially life-threatening benign tumor of the respiratory tract with laryngeal predilection. The diagnosis of recurrent respiratory papillomatosis may be challenging unless there is a high index of suspicion and awareness of the variable presentations.

METHODS. We reviewed the medical charts of children with recurrent respiratory papillomatosis treated at a tertiary children’s hospital. The presentation of recurrent respiratory papillomatosis is illustrated by a series of case reports. We provide a paradigm to assist in the early diagnosis of children with recurrent respiratory papillomatosis.

RESULTS. Five patients, aged 2 to 6 years, were erroneously diagnosed with recurrent croup, asthma, laryngeal hemangioma, and tracheomalacia after presenting with variable degrees of chronic dyspnea, cough, stridor, dysphonia, weak cry, and syncope. Once the diagnosis of recurrent respiratory papillomatosis was made, recurring surgical ablation of papillomata was initiated.

CONCLUSIONS. Any child presenting with a voice disturbance with or without stridor is recommended to have diagnostic flexible fiber-optic laryngoscopy. Recurrent respiratory papillomatosis should be considered in children when other common pediatric airway diseases either do not follow the natural history or do not respond to treatment of the common disorder.

Key Words: pediatric • recurrent respiratory papillomatosis • human papilloma virus • asthma • croup • stridor • hoarseness

Abbreviations: RRP—recurrent respiratory papillomatosis • HPV—human papillomavirus • ED—emergency department • URI—upper respiratory infection • FFL—flexible fiberoptic laryngoscopy

Accepted Jun 13, 2006.


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