Gazan with rare ‘tree man’ syndrome saved at Hadassah

"The experts here were the only ones who gave me hope for recovery."

By JUDY SIEGEL-ITZKOVICH
Updated: AUGUST 30, 2017 13:59
The hand of a Gaza resident who suffers from an extremely rare condition called “tree man syndrome” (photo credit: HADASSAH UNIVERSITY MEDICAL CENTER)
The hand of a Gaza resident who suffers from an extremely rare condition called “tree man syndrome”
(photo credit: HADASSAH UNIVERSITY MEDICAL CENTER)
Jerusalem doctors have saved the hand of a 42-year-old Gaza father of six who suffers from an extremely rare condition called epidermodysplasia verruciformis or “tree man syndrome” in which tumors cover various parts of the body.
Dr. Michael Chernofsky, an orthopedist and plastic surgeon at Hadassah University Medical Center in Ein Kerem and colleagues treated Muhammad Taluli, who could not find anyone in Gaza, Egypt, the Palestinian Authority or elsewhere in Israel to treat him and recently arrived at Chernofsky’s clinic desperate for medical advice.
“This was a very rare case that has no documentation whatsoever in the medical books,” said Chernofsky. “The patient had many complex tumors that filled the entire hand for more than 10 years. Besides the strong pains and his inability to move or use his hand, the disease is very dangerous and can develop into cancer. He became introverted and ashamed, unwilling to expose his hand to others. It was covered all the time.
The recessive genetic condition is a complication of human papillomaviruses (HPV) that the body is not strong enough to cope with.
According to Chernofsky, there are different types of HPV that cause various tumors.
“Most people have an immune system that can cope with the virus or can be controlled by drugs. In the case of Muhammad, from the rare cases in the world, the defective immune system is unable to treat the virus and allows it to develop in an exaggerated and uncontrollable manner.”
Chernofsky conceded that he had never seen a case of tree man syndrome, but had heard of one Bangladeshi named Abul Bajandar who was diagnosed with it last year and needed 16 operations to remove all the tumors from the patient’s hands.
“I have a lot of experience with difficult and complicated cases,” he stressed, “but there is no documentation in the professional literature of how to treat such a condition. When he came to us, the decision to perform the operation was not easy to make.”
The Hadassah surgical team, which included orthopedic specialist Dr. Shai Luria, prepared for the operation and its complicated procedure.
“We investigated the syndrome as much as possible to understand what treatment would be most effective,” Luria explained. “We should have cauterized all the tumors, but that would have spread smoke in the operating room and endangered the medical team. The idea was to create a plan to reduce the risk of tumors growing so wildly again.
“With a team of dermatologists and the operating room staff, we made special arrangements in the operating room because it is a highly contagious disease, so we worked with double shielding and special masks to prevent the virus from spreading.”
The patient’s own skin had to be taken from elsewhere in the body to cover up what was left after the tumors were removed surgically. Dermatologist Dr. Vered Molcho gave him a special vaccine to attack the virus from within the body and try to prevent the tumors from returning.
“We seem to have chosen the correct surgery and complementary treatment for him. We are optimistic. Now his hand looks like a hand with a large burn on it. We are following the recovery very carefully, and he has already started occupational therapy, which will help him to use the hand he has not utilized for many years,” the doctors said.
A few days after the operation, Taluli’s condition is satisfactory.
“After a decade in which I sat embarrassed at home and could not work because of the limitations and I was afraid of cancer, the experts here at Hadassah were the only ones who gave me hope for recovery,” he said. “The treatment here is excellent and everything is good. I very much hope that my previous life is already behind me, and I am waiting to see my family, my wife and my six children.”