A 29-year-old man was seen with recurrent warts unresponsive to prior cryotherapy, podophyllin, and imiquimod cream treatment. The patient had been diagnosed in 2004 as having WHIM syndrome (a primary immunodeficiency manifesting as warts, hypogammaglobulinemia, infections, and myelokathexis1) after a hospital admission for recurrent pneumonia, leukopenia, and anemia. Subsequent genetic testing identified the characteristic heterozygous CXCR4 mutation (GenBank AF052572). A hematologic and immunologic workup revealed pancytopenia. The patient had normal immunoglobulin levels and antibodies to diphtheria, tetanus, Streptococcus pneumoniae, and influenza. Bone marrow biopsy findings were consistent with myelokathexis.
Palm MD, Tyring SK, Rady PL, Tharp MD. Human Papillomavirus Typing of Verrucae in a Patient With WHIM Syndrome. Arch Dermatol. 2010;146(8):918-935. doi:10.1001/archdermatol.2010.184