Images of Note: Debilitating Warts in a Transplant Patient

By Christopher C. Surek, DO, Gehaan F. D’Souza, MD, and James E. Zins, MD

A 25-year-old woman presented with extensive, severe plantar warts on her feet seven years post orthotopic heart transplant. She had been on mycophenolate mofetil and tacrolimus since transplantation. For four years, severe plantar warts on her feet had resulted in severe pain and reduced quality of life. She was non-weight-bearing and couldn’t work.

Prior to presenting to our outpatient clinic in the Department of Plastic & Reconstructive Surgery, she had been seen by multiple doctors and at one point was even advised to undergo an amputation. She received a wide variety of treatments including chemical ablation with salicylic acid, topical fluorouracil and carbon dioxide labor therapy, all ineffective. Her exam showed exophytic warty growths on the bottoms of her feet with associated lower pedal edema.

We determined that a human papilloma virus (HPV) infection caused the warts and decided to surgically excise large portions of the warts to decrease their size. We then treated her with topical cidofovir for three months, and the lesions slowly disappeared.

The patient is now weight-bearing, back to work and back to hobbies she once enjoyed like dancing.

Images reprinted with permissions from Massachusetts Medical Society. This case was published in New Eng J Med in July 2017.

Dr. Surek is an aesthetics fellow in the Dermatology & Plastic Surgery Institute. Dr. D’Souza is a former Cleveland Clinic fellow. Dr. Zins is Chair of the Department of Plastic and Reconstructive Surgery.