Successful treatment of verruca vulgaris with Thuja occidentalis in a renal allograft recipient
A 34-year-old male, a clerk by profession underwent a living donor renal transplantation in 2006 and was maintained on cyclosporine (150 mg daily), prednisolone (10 mg daily), and mycophenolate mofetil (1500 mg daily). He did not receive lytic induction. He was anti-HCV positive and received a 6-months course of interferon alpha 2b before transplantation. During early post-transplant period, he had acute cellular rejection Banff type II A, requiring three doses of methyl prednisolone. There were no opportunistic infections or reactivation of HCV during the 1st year of follow-up.\nA year after transplantation, he developed multiple warty lesions on the dorsum of the fingers of both hands suggestive of verruca vulgaris. These lesions were treated with cryotherapy, cauterization, and radiosurgery with marginal improvement. However, 4 months later, the distal end of the right middle finger revealed ischemic changes and necrosis, needing amputation of distal two phalanges []. Histology of the amputated finger showed nests of malignant squamous cells with keratin pearls infiltrating the dermis []. He returned to our center where excisional biopsies of few existing warts were done. Histology showed hyperkeratosis, parakeratosis, acanthosis and prominent giant eosinophilic keratohyalin granules and eosinophilic intranuclear inclusions with viral cytopathic effect, and mild dysplasia consistent with verruca vulgaris []. Human papillomavirus (HPV) genotype Ia was identified from the specimen. Having lost part of the finger on the right hand, the patient had crippling anxiety and fear that the remaining warts would claim his other fingers and his livelihood. Cyclosporine was replaced with everolimus. Ketoconazole augmentation was given for cost reduction. Cryotherapy and cauterization failed over the next 6 months. At this time, the patient was treated with Thuja occidentalis (T. occidentalis) extract, orally and topically for a period of 7 days at his native place. For external applications, he received mother tincture and as oral preparation he was given potentized medium (power 1m= 1000 times) T. occidentalis as 2 globules thrice a day. By the end of 3rd week of therapy, the warts dropped off leaving only small superficial scars []. The allograft function remained unaffected at creatinine of 1.5 mg/dl. He has been followed up for one year and has not had any recurrence.