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After 24 Surgeries, Bangladesh’s Tree Man Faces More Operations with Return of Bark-like Growths

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Doctors who performed 24 surgeries on Abdul Bajandar, the Bangladeshi man with epidermodysplasia verruciformis, said his case appears to be more complicated than they initially thought. He is now scared of undergoing more surgeries, but it seems inevitable because 12 months after the series of operations, wood-like warts on his hands and feet are back.

Because of the rare genetic condition, more than five kilos of growths were removed from his body in 2016. By January 2017, the doctors were optimistic that Bajandar would be able to leave the hospital soon and return to a normal life, Agence France-Press reported.

Malignant tumors

More than the difficulty in movement caused by the bark-like growth, people like Bajandar with the condition are more susceptible to human papillomavirus infections on their skin, according to a 2010 report. It could further lead to the formation of skin lesions that can progress to malignant tumors in about 50 percent of the patients.

Like other ailments, there is no definitive cure for epidermodysplasia verruciformis, the study said. It is a constant struggle to find ways to address the skin lesions in patients with the condition. Besides surgery, one possible alternative is to treat the patient with retinoids, drugs that curb the growth of cells that are sometimes used to treat skin conditions. Another medicine is interferon, a protein produced by the body to battle viruses.

Although some of the treatments could be helpful, there is a wide variation of how patients respond to the medication. Among the few treatment options, none seems to be curative. Lesions usually recur after the treatment stops.

Unbearable pain

Bajandar previously described the pain caused by his condition as an unbearable pain, Newser reported. He, his wife, and four-year-old daughter are living in the Dhaka Medical College Hospital where Bajandar is receiving the free treatment.

The 27-year-old rickshaw driver said after his series of surgeries that seemed to have cured him that he hopes the curse will not return again, Daily Mail reported. The excruciating condition forced Bajandar to stop working, causing him to worry about the future of his daughter.

After the procedures, the Bajandar – who was in the hospital for around 30 days – said he was happy that he could hold his daughter in his lap and play with her. He met Halima Khatun, his wife, before he contracted the disease. Bajandar previously thought that the warts were harmless until it grew and covered his limbs that he was forced to stop working.

After the surgeries, Samanta Lal Sen, the surgeon at Dhaka Medical College Hospital said the procedures were a remarkable milestone in the history of medical science. Bajandar is believed to be one of four cases of EV worldwide. But it appears that the surgeon spoke too soon.

Bajandar is described as the most loved patient at Dhaka Medical College Hospital. When his case was first publicized in 2016, he received some money from well-wishers from all over the world. The former rickshaw driver planned to set up a small business to ensure a good future for his daughter, Daily Star reported. However, it appears he has to set aside all plans for now and must undergo more surgeries and hope the tumors will never return.

Sun-exposed areas

According to Medscape, the malignant skin tumors develop frequently in sun-exposed areas. It usually starts to show between the ages of 20 and 40, reflecting the high-risk nature of HPV infections. Because the skin cancers usually appear on the face, neck, chest, and arms, it indicates the role of ultraviolet light and HPV infection in the promotion of skin cancer development.

Multiple types of HPV usually infect EV patients, including the common types that affect individuals without the disease such as HPV types 3 and 10 as well as those unique to EV-associated HPVs. There are more than 30 EV-HPVs such as types 4, 5a, 5b, 8, 9, 12, 14, 15, 17, 19-25, 36-38, 47, and 50 which have been identified in EV lesions.

Up to 20 percent of the non-EV population has been detected in some EV-HPVs, but it is only pathogenic in EV patients. In more than 90 percent of EV-associated squamous cell carcinomas, HPV-5 and HPV-8 have been isolated.

Medscape noted that while EV is commonly inherited in an autosomal recessive manner, it has been described as sporadic and gender-linked. There may be a history of consanguinity in the parents of the EV patient in the cases of autosomal recessive inherence. In cases of atypical inheritance, the association could be with chronic lymphopenias.

Whatever is the mode of inheritance, the disease is characterized by chronic infection with HPV. There are widespread skin eruptions of flat-to-papillomatous, wart-like lesions and reddish-brown pigmented plaques on the trunk, hands, upper and lower extremities, and the face.

[메디컬리포트=​Vittorio Hernandez 기자]

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