Images in Clinical Medicine
Digital Verrucae
N Engl J Med 2008; 359:177July 10, 2008
- Article
A 34-year-old woman underwent renal transplantation for chronic idiopathic glomerulonephritis, and 4 years later small verrucae developed on her distal fingertips. Over the course of 11 years after transplantation, during which time she was on a stable immunosuppressive regimen, the verrucae progressed to confluent and dense periungual filiform verrucae, with digital encirclement on the first four fingers of her right hand (Panel A) and involvement of the nails (Panel B); verrucae also developed, to a lesser extent, on her left hand (Panel C). Attempts to remove the verrucae were made but were unsuccessful because of trypanophobia (fear of needles). Ultimately, the patient underwent topical therapy followed by snip excision, which led to substantial debulking but incomplete removal. Progression of conditions associated with human papillomavirus, such as cutaneous warts, is common in patients receiving long-term immunosuppressive therapy after transplantation. In such cases, careful surveillance is warranted.
Nektarios I. Lountzis, M.D.
Omar Rahman, M.D.
Geisinger Medical Center, Danville, PA 17822
