Severe Plantar Warts in an Immunocompromised Patient Case

diagnosis

A 25-year-old woman who had undergone orthotopic heart transplantation presented to a plastic surgery clinic with a 4-year history of extensive warts on both feet (Panel A). The lesions had first developed 7 years after the cardiac transplantation and resulted in considerable pain, swelling, and disability. She had been receiving immunosuppressive therapy with mycophenolate mofetil and tacrolimus since transplantation. Previous treatments for the warts that included topical chemical ablation with salicylic acid, topical fluorouracil, and carbon dioxide laser therapy had been ineffective. A physical examination revealed exophytic warty growths on the plantar surface of the metatarsal and heel regions of both feet, with associated lower pedal edema. These cutaneous warts are caused by infection with human papillomavirus. The patient underwent one aggressive debulking procedure, followed by treatment with topical cidofovir twice a day for 3 months, with no change to her immunosuppression regimen. Over these 3 months, the lesions gradually disappeared (Panel B). She became able to bear weight without difficulty, and her quality of life improved.

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