International report - Indonesia's "Treeman," whose body is disfigured with tree-branch-like warts, is getting better - but he is far from being free of the chronic HPV-2 virus that has overrun his body.
About a year and a half since an initial visit to Indonesia with the Discovery Channel to consult on the case of Dede Kosawa, U.S. dermatologist Anthony Gaspari, M.D., says that Mr. Kosawa has had extensive medical care.
"Dede was discharged from the hospital in the beginning of September. He had been in the hospital for nine months, and was treated for tuberculosis in the lung.
In June 2007, Discovery Channel invited Dr. Gaspari to travel to Indonesia to consult on Mr. Kosawa's case. Dr. Gaspari diagnosed Mr. Kosawa with the common wart virus.
But because Mr. Kosawa also has immunodeficiency, a genetic flaw, the HPV-2 was able to spread quickly around his body, resulting in the growth of tree-limb-like cutaneous horns.
Advice from afar
Dr. Gaspari returned to Indonesia in March 2008, again as a consultant on the case. However, the 36-year-old patient's daily care is in the hands of local doctors.
"Basically, I gave the doctors advice on treatment," Dr. Gaspari says.
"What I had recommended was that I agreed with cutting off the horns and massive growths on his hands. Now, you can see the outlines of his hands.
The removed horns made up 14 pounds of Mr. Kosawa's 100 pounds of body weight.
"So, 14 percent of his total body weight was the dead, cutaneous horns. For a little man, that is a lot of weight to be carrying around. Just removing that weight has to make him feel better," Dr. Gaspari says.
The dermatologist says the horns will grow back, but to lessen the trauma of the continued growth, Dr. Gaspari recommended that the local dermatologists use salicylic acid to keep the tissue soft and at bay.
The doctors' attempt to treat Mr. Kosawa with acitretin was unsuccessful. While the synthetic retinoid slowed the growth of the warts slightly, it did not flatten them, according to Dr. Gaspari.
Pharma company donates
With Dr. Gaspari's help, the Indonesian doctors started Mr. Kosawa on cidofovir (Gilead Sciences) in September. Securing the drug treatment proved challenging.
"They do not have cidofovir in Indonesia, so I approached the pharmaceutical industry in the U.S. to give it to him, compassionately.
"I hoped that would take weeks, but it took six months.
"Why? Ours would be an off-label use of cidofovir, and Dede is an international patient, so there are a lot of regulatory issues," Dr. Gaspari says.