A Fatal Case of Kaposi Sarcoma Due to Immune Reconstitution Inflammatory Syndrome.

Jan 2012

Stover KR, Molitorisz S, Swiatlo E, Muzny CA.

Source

From the Department of Pharmacy Practice (KRS), University of Mississippi School of Pharmacy; Division of Infectious Diseases, Department of Medicine (KRS, ES), University of Mississippi Medical Center, Jackson, Mississippi; Infectious Diseases Group (SM), St. Dominic Memorial Hospital; and Division of Infectious Disease, Department of Medicine (CAM), University of Alabama at Birmingham, Birmingham, Alabama.

Abstract

The prevalence of AIDS-related Kaposi sarcoma (KS) has markedly declined in the era of highly active antiretroviral therapy(HAART) although it remains one of the most common AIDS-defining malignancies. Although immune reconstitution inflammatory syndrome (IRIS)-related KS (IRIS-KS) represents only a fraction of the IRIS cases, it can be a life-threatening situation. This report describes a fatal case of IRIS-KS. A 32-year-old man with HIV/AIDS was initiated on HAART and experienced rapid immunological and virological response to therapy. He subsequently experienced progressively severe dyspnea and papulonodular skin lesions and was admitted to the hospital with hypoxic respiratory failure. Bronchoscopy revealed numerous friable endobronchial lesions. Histopathology of a skin lesion was consistent with KS. The relatively rapid progression of disease in the setting of improvement in immune function after initiating HAART suggested IRIS-KS. This report reviews previously published cases of IRIS-KS and describes risk factors, immunopathogenesis and treatment options.

American Journal of Medical Sciences

Topical treatment of cutaneous Kaposi sarcoma with imiquimod 5% in renal-transplant recipients: a clinicopathological observation.

Feb 2012

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Prinz Vavricka BM, Hofbauer GF, Dummer R, French LE, Kempf W.

Source

Department of Dermatology, University Hospital, Zürich, Switzerland.

Abstract

Kaposi sarcoma (KS) is a vascular neoplasm pathogenetically linked to human herpesvirus 8. Transplant recipients, in particular renal-transplant recipients (RTRs) are at higher risk for post-transplant (P)-KS which affects 0.2-11% of RTRs. The course of P-KS is influenced by the post-transplantation immunosuppressive treatment. Reduction of immunosuppressive drugs can result in tumour regression, and is the treatment of choice for P-KS, but is associated with the risk for transplant rejection. Imiquimod is a topically applied immunomodulator without relevant systemic absorption, and may thus represent a promising treatment for cutaneous KS in RTRs. The aim of this study was to investigate the clinical and histological effects of imiquimod in two RTRs with cutaneous KS. Imiquimod resulted in complete clinical and histologically proven remission in one patient, but in the second patient, although there was clinical remission, histological persistence of KS was found. Imiquimod may represent an effective treatment for RTRs with cutaneous P-KS. However, clinical remission does not necessarily indicate complete tumour regression, as shown in one of our patients, who had a persisting tumour, as shown by biopsy examination. Thus, histological confirmation is crucial to confirm complete response.

British Association of Dermatologists.

Wiley Online Library

Pedal Presentation of Kaposi's Sarcoma in a Non-HIV Hispanic Female: A Case Report and Literature Review.

Feb 2012

Basalely D, Khan KH, Cavazos GJ, D'Antoni AV, Bakotic BW.

Source

Fourth Year Student, New York College of Podiatric Medicine, New York, NY.

Abstract

Keywords:

• biopsy;
• cancer;
• immunocompromise;
• malignancy;
• surgery;
• toe;
• tumor

Kaposi's sarcoma is divided into 5 subtypes primarily differentiated by clinical presentation and typical at-risk population. We report the unique case of a 74-year-old Latin American woman who presented with a violaceous lesion on the dorsum of her right second digit, which was diagnosed as Kaposi's sarcoma but was not easily placed into a discrete subtype. We discuss the factors that usually predispose people to this infection and the lack of those factors in our patient, as well as the subsequent treatment of our patient. The patient remained in complete remission at 4 years follow-up.

Elsevier

Simultaneous Breast Cancer and Kaposi's Sarcoma Complicating Rheumatoid Arthritis.

Sept 2011

Barak F, Reitblat T.

Source

Oncology Institute, Barzilai Medical Center, Ashkelon, Affiliated to the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel.

Abstract

Key Words: Secondary cancers, Rheumatoid arthritis, Methotrexate, Vinorelbine, Kaposi's sarcoma

For a number of years we have been following the medical literature to find a relationship between chronic treatment with methotrexate and breast cancer occurrence, because we had had in our clinic a female patient who had had two consecutive cancers following methotrexate treatment for rheumatoid arthritis (RA). We were much surprised to find in some papers that breast cancer incidence is low in women with RA. Since then, we have found several papers explaining the low incidence of breast cancer among women being under NSAIDs, but those papers are not univocal. Methotrexate is a known antifolate agent and it has been demonstrated that dietary shortage of folate is a risk factor for breast cancer development.

PubMed - Karger

Kaposi's sarcoma: case report and treatment options.

Oct 2011

Tan WC, Chan LC.

Source

Department of Dermatology, Hospital Pulau Pinang, Penang, Malaysia. tanwooichiang@yahoo.com

Abstract

Kaposi's sarcoma (KS) is strongly associated with Human Herpes Virus 8 (HHV8) and Human Immunodeficiency Virus infection (HIV). It was the first malignancy to be linked with Acquired Immunodeficiency Syndrome (AIDS). We report a case of Kaposi's sarcoma in a newly diagnosed retroviral homosexual patient with CD4 count of 21. He had multiple firm discrete violaceous plaques and nodules scattered over the face, scalp, hard palate, trunk and genitalia. Biopsy of a skin nodule over the trunk and a biopsy of a lesion from the gastric mucosa confirmed Kaposi's sarcoma. He was started on Highly Active Antiretroviral Therapy (HAART) and cryotherapy (liquid nitrogen) was given for the lesions over the skin. He responded well to treatment. Liquid nitrogen is a useful adjuvant treatment for Kaposi's sarcoma.

PubMed

Kaposi sarcoma of the ureter after liver transplant: case report and literature review.

Chen Y, Zhao L, Qiu SP, He X.

Source

From the Department of Urology, The First Affiliated Hospital, SUN Yat-sen University, Guangzhou 510080, China.

Abstract

Keywords: Kaposi sarcoma, Ureter, Liver transplant, Radical nephroureterectomy, Sirolimus

Kaposi sarcoma after an organ transplant is rare and infrequently involves internal organs. There are 2 reported cases in the English literature of Kaposi sarcoma originating from the transplant ureter after kidney transplant. We report a case ofKaposi sarcoma that occurred in the native ureter of the liver transplant recipient. Initially, the patient refused any further investigation and management and 2 years subsequent, had to undergo a left radical nephroureterectomy owing to the loss of renal function and distending pain. He recovered very well and no recurrence was detected at 47 months' follow-up. To our knowledge, it is the first report in English. We review the literature on this topic and explore the therapeutic principles and histologic features of this sarcoma.

ECTRX.org

Kaposi's Sarcoma Associated Herpesvirus Entry into Target Cells.

2012

Chakraborty S, Veettil MV, Chandran B.

Source

H. M. Bligh Cancer Research Laboratories, Department of Microbiology and Immunology, Chicago Medical School, Rosalind Franklin University of Medicine and Science North Chicago, IL, USA.

Abstract

Herpesvirus infection of target cells is a complex process involving multiple host cell surface molecules (receptors) and multiple viral envelope glycoproteins. Kaposi's sarcoma associated herpesvirus (KSHV or HHV-8) infects a variety of in vivo target cells such as endothelial cells, B cells, monocytes, epithelial cells, and keratinocytes. KSHV also infects a diversity of in vitro target cells and establishes in vitro latency in many of these cell types. KSHV interactions with the host cell surface molecules and its mode of entry in the various target cells are critical for the understanding of KSHV pathogenesis. KSHV is the first herpesvirus shown to interact with adherent target cell integrins and this interaction initiates the host cell pre-existing signal pathways that are utilized for successful infection. This chapter discusses the various aspects of the early stage of KSHV infection of target cells, receptors used and issues that need to be clarified, and future directions. The various signaling events triggered by KSHV infection and the potential role of signaling events in the different stages of infection are summarized providing the framework and starting point for further detailed studies essential to fully comprehend the pathogenesis of KSHV.

Frontiers

Upper gastrointestinal bleeding due to gastric and duodenal Kaposi´s sarcoma.

Feb 2012

Bello Rodríguez L, Pardeiro Pértega R, Couto Wörner I, Vázquez Rodríguez P, López Calvo S, Castro Iglesias MA, Mena de Cea A, Alonso Aguirre P, Pedreira Andrade JD.

CASE REPORT

A 30-year-old homosexual male was recently diagnosed with HIV infection (category A2). He was been admitted into the hospital because of anal pain and diarrhea of 8 months. He presented purplish cutaneous lesions, laterocervical adenopathies and a palpable anal mass. The rest of physical exploration did not reveal any other significant alteration. The amount of CD4 was 350 cells/mL and the viral load of 10,000 copies/mL. Fecal cultures were negative. A colonoscopy was performed and detected an ulcerated rectal mass that was biopsied (Fig. 1). He presented an episode of hematemesis so it was performed an upper endoscopy which demonstrated the presence of lesions suggestive of Kaposi’s in the stomach (Fig. 2) and duodenum (Fig. 3). The definitive anatomopathologic diagnosis of the cutaneous anal lesion, gastric biopsy and adenopathies was Kaposi’s sarcoma. The patient began antiretroviral treatment and

chemotherapy with liposomal doxorubicin and radiotherapy.

DISCUSSION

Kaposi’s sarcoma is a vascular tumor described first in 1872. It is associated with the immunosuppressive state in patients affected by infection with HIV. It usually appears as small purplish cutaneous lesions although it can affect other mucosa, organs and lymphatic system. Postmortem studies suggest the presence of visceral involvement in more than 75% of the

cases, being the lungs and gastrointestinal tract the most common ones. It can affect any part of the digestive tract, from the oropharynx to the rectum. They have been described cases of hepatic, splenic and pancreatic disease (1). Gastrointestinal Kaposi’s sarcoma frequently has a silent clinical course although it can cause abdominal pain, gastrointestinal bleeding and

intestinal obstruction (2). Endoscopically it can presents as a purplish nodule, a polipoid mass or a hemorragic macule (3).

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