We describe here a case of high-grade vaginal squamous lesion in a 54-year-old woman with a papillomaviruses (HPV) genital infection that developed from a cervical low-grade squamous intraepithelial lesion (SIL) to a high-grade SIL (H-SIL) on cytological examination. A colposcopy exam led to the detection of suspect vaginal lesions with granulomatous infiltrations, which were classified as a Vaginal Intra-Epithelial Neoplasia grade 2 after pathologists' analyses. After a laser vaginal surgery and a loop excision of the transformation zone, the analyses of the anatomical pieces using a near-complete HPV screening panel revealed an HPV-4 infection that was not detected before in cervical smears. This HPV-infection is associated with a high human herpesvirus type 6A (HHV-6A) viral load in the same anatomical piece. The presence of an inherited chromosomally integrated HHV-6A (iciHHV-6A) was proved in this patient by real-time polymerase chain reaction on hair follicles and nail. This case suggests reconsidering both the benign nature of low-grade lesions in the female genital tract and the well-known “good” prognosis of low-risk HPV infection, especially when iciHHV-6A is diagnosed. This clinical course insists on the benefits of the multiplex panel use or global sequencing in order to optimize biological testing sensitivity, and so enhance clinical management of infection-induced neoplasia.

Maver PJ, Kocjan BJ, Seme K, Poljak M: Genomic diversity of low-risk human papillomavirus genotypes HPV 40, HPV 42, HPV 43, and HPV 44. J Med Virol 2014;86:272-282.
Muñoz N, Bosch FX, de Sanjosé S, Herrero R, Castellsagué X, Shah KV, et al: Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med 2003;348:518-527.
Agut H, Bonnafous P, Gautheret-Dejean A: Update on infections with human herpesviruses 6A, 6B, and 7. Med Mal Infect 2017;47:83-91.
Mardivirin L, Descamps V, Lacroix A, Delebassée S, Ranger-Rogez S: Early effects of drugs responsible for DRESS on HHV-6 replication in vitro. J Clin Virol 2009;46:300-302.
Grussendorf-Conen EI, Gissmann L, Hölters J: Correlation between content of viral DNA and evidence of mature virus particles in HPV-1, HPV-4, and HPV-6 induced virus acanthomata. J Invest Dermatol 1983;81:511-513.
Lusso P, Malnati MS, Garzino-Demo A, Crowley RW, Long EO, Gallo RC: Infection of natural killer cells by human herpesvirus 6. Nature 1993;362:458-462.
Alvarez-Lafuente R, De las Heras V, Bartolomé M, Picazo JJ, Arroyo R: Relapsing-remitting multiple sclerosis and human herpesvirus 6 active infection. Arch Neurol 2004;61:1523-1527.
Razzaque A: Oncogenic potential of human herpesvirus-6 DNA. Oncogene 1990;5:1365-1370.
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