Recalcitrant hyperkeratotic warts in a renal transplant recipient clearing with cessation of immunosuppression

Background: We describe a case of a 45-year-old female renal transplant recipient who had an 8 year history of multiple, hyperkeratotic proliferative recalcitrant warts on her hand and exophytic lesions on her vulval area. Initially, this started as one wart on her right middle finger and slowly progressed to multiple warts.
Treatment: The patient, who was on mycophenolate mofetil, tacrolimus and oral prednisolone, was treated with combinations of liquid nitrogen cryotherapy, salicyclic acid ointment (50%), topical diphenylcyprone therapy, cantharidine and podophyllin (Cantharone plus), trichloroacetic acid and even intralesional bleomycin. Despite all of these treatments, which were administered weekly to fortnightly for months, the difficult hand warts remained.
In mid 2016 the patient's graft failed, immunosuppression was withdrawn and peritoneal dialysis commenced. The hand and viral warts cleared within one week on minimal therapy.
Discussion: Viral warts in immunosuppressed patients can be extremely recalcitrant to treatment, clearing only after removal of immunosuppression.

Dr. Danit Maor

Skin & Cancer Foundation Inc., Victoria, Australia

Dr Danit Maor completed a Bachelor of Medicine and a Bachelor of Surgery (MBBS) at the University of Western Australia. She is currently the Occupational Dermatology Research fellow at the Skin & Cancer Foundation, Inc. in Victoria.
Last year she was the Research and Education Fellow at the Skin & Cancer Foundation focussing on transplant dermatology, research and educational workshops on a variety of different dermatological skills and topics.
Danit is due to complete a Masters of Public Health and Tropical Medicine in December this year.