gms | German Medical Science

Objectives/Interrogation: Epidermodysplasia verruciformis or tree man syndrome is a rare inherited skin disorder which creates wart-like lesions anywhere on the body. It is caused by abnormal susceptibility to human papillomaviruses (HPVs), which eventually leads to the overgrowth of widespread skin eruptions, including wart-like lesions and reddish-brown pigmented plaques, especially on the feet and hands. He was not able to maintain his normal activites without others assistances.

Although several types of HPVs contribute to this condition, HPV types 5 and 8 are most commonly associated with tree man illness. Notable cases include a Romanian man named Ion Toader who was diagnosed with the condition in March 2007, and the Dede Koswara, from Indonesia. Our case, Mr. Abul Bazander is the third reported case of the world who was treated successfully.

Methods: We evaluated the patient and the histopathology report revealed Filiform viral wart (verruca) without dysplasia or evidence of malignancy. 14 high risks and 5 low risks strains of HPV from wart tissue were isolated by real-time PCR.

We applied a special technique of dressing to make the lesions soft, termed as 'surgical marination'. The bark-like lesions were excised gradually using electro-dissection and surgical scissors. It took 24 surgical sessions under regional block to make his limbs free of lesions.

Results and Conclusions: The hands and lower limbs were free from the lesion and the tree man was able to maintain his personal care and day to day activities without help. So, it is a success story for a developing country.