Recurrent respiratory papillomatosis juvenile: a retrospective analysis at Hospital Santo Antônio

Objective To describe the profile of patients with Recurrent respiratory papillomatosis juvenile treated at a Brazilian tertiary referral center, including disease severity assessed with the Derkay staging system. Methods This retrospective observational case series included patients younger than 18 years with histopathologically confirmed who underwent laryngeal surgery and outpatient follow-up. Medical records from January 2014 to December 2025 were reviewed. Demographic, clinical, surgical, recurrence, airway, adjuvant-treatment, mortality, and Derkay-score data were analyzed descriptively. Results Seventeen patients were included; 10 were female (58.8%) and 7 were male (41.2%). The mean age at symptom onset was 5.23 ± 3.73 years, and isolated dysphonia was the most common initial presentation (70.6%). Dysphonia associated with dyspnea occurred in 29.4% of patients. A total of 53 surgical procedures were performed, corresponding to a mean of 3.12 procedures per patient. Disease recurrence occurred in 12 patients (70.6%), and 4 patients (23.5%) required tracheostomy. One patient with extensive tracheal involvement received intralesional and systemic bevacizumab, with subsequent decannulation and no need for repeat tracheostomy. Two patients died from disease-related complications. Among 12 patients with serial Derkay assessments, the score decreased in 11 (91.7%) and remained stable in 1 (8.3%); the mean total score declined from 10.94 to 7.00 points. Conclusions Recurrent respiratory papillomatosis juvenile was associated with substantial morbidity, frequent recurrence, repeated surgical interventions, tracheostomy, and mortality in this Brazilian pediatric cohort. Dysphonia should prompt early specialized evaluation, particularly when accompanied by dyspnea. Limited access to CO 2 laser, pediatric bronchoscopy, HPV subtyping, and adjuvant therapies may increase the clinical burden in public referral settings. Multicenter studies are needed to clarify prognostic factors and evaluate the impact of HPV vaccination and adjuvant treatments. National data from Brazilian public referral centers remain limited. Level of evidence 4.