Dede Koswara, the Indonesian man known worldwide as the "Tree Man," is battling a recurrence of the massive warts that have covered much of his body since he was a teenager.
Koswara underwent surgery in August 2009 to remove many pounds of the hardened tissue, but the growths are now recurring, particularly over his hands and feet, according to Anthony Gaspari, M.D., the U.S. dermatologist who first diagnosed Koswara in 2007.
Dr. Gaspari, professor and chairman of the department of dermatology, University of Maryland School of Medicine, Baltimore, traveled to Indonesia with the Discovery Channel in 2007 to consult on what appeared to be disfiguring tree-like branches growing from Koswara's body, limbs and face.
Dr. Gaspari returned to Indonesia in March 2008 to consult with local doctors managing Koswara's case. Back then, Dr. Gaspari agreed with cutting off the horns and massive growths on Koswara's hands and face, but advised against extensive surgery on his body.
In August 2009, doctors in Indonesia removed more than 13 pounds of warts - more than one-tenth of Koswara's body weight.
Dr. Gaspari says the warts on Koswara's hands and feet were not excised, but rather debrided.
"At the base of the horns is the HPV-infected skin tissue," he says. "I expected the warts to recur, and this is exactly the reason I advised the Indonesian doctors against extensive surgery. Surgical excision of warts will temporarily improve, but not cure, the wart infection."
Surgical treatment has failed to address Koswara's underlying immune defect.
"I had obtained an antiviral drug (cidofovir), which, if effective, would have reduced the wart infection. We gave this treatment to Dede last year," Dr. Gaspari says.
"Unfortunately, this treatment was toxic to his kidneys, so we were never able to determine if it exhibited the desired effects," he says.
Interferon an option
The dermatologist has another option, but can only hope that it becomes a reality for the man who only briefly was able to hold a cell phone and a fishing pole.
"I want to give Dede immune-stimulating treatments, such as interferon, to boost his immunity against the wart virus," Dr. Gaspari says. "I do need to have some insight into his disease process before I give him such a treatment.
"I have not been able to understand his process because the Indonesian government has an embargo on sending his specimens to the United States. I have invited the Indonesian doctors to come to the U.S. to study Dede's condition in my lab, and they are interested, but this has not happened yet."