Eosinophilic panniculitis presenting with Kaposi's sarcoma-like plaques in a patient who is human immunodeficiency virus positive: a case report.

Nov 2012

Ustuner P, Dilek N, Saral Y, Dilek AR, Bedir R.

Abstract

INTRODUCTION: Eosinophilic panniculitis is an unusual type of panniculitis characterized by a prominent infiltration of subcutaneous fat with eosinophils without an exact etiopathogenesis. To the best of our knowledge, up to now eosinophilic panniculitis has been described in only one previous case with human immunodeficiency virus disease in the literature.

CASE PRESENTATION:

Here we report the case of a 44-year-old Caucasian man, who is human immunodeficiency virus positive, diagnosed with eosinophilic panniculitis. A dermatological examination revealed multiple, confluent Kaposi's sarcoma-like purple colored, deep plaques and nodules on his right gluteal area and right thigh. The presence of the mixed inflammatory infiltrate of lymphocytes, macrophages, and numerous eosinophils involving both septa and lobules of the subcutis were noted on the histopathological examination. On the basis of all these clinical and histopathological findings the patient was diagnosed with eosinophilic panniculitis. He was given intravenous 60mg/day methylprednisolone for 3 consecutive days a week for 6 months. The lesions resolved almost completely after 6 months.

CONCLUSION:

The predominance of T helper-2 subset of T helper cells and the consequential increase in interleukin-5 cytokines accompanying peripheral eosinophilia and high serum immunoglobulin E levels may all be blamed for the development of eosinophilic panniculitis in our case study. As a result, we aim to emphasize that eosinophilic panniculitis should be kept in mind in the differential diagnosis of subcutaneous nodular lesions in patients who are human immunodeficiency virus positive. We also focus on the requirement of histopathological examination for the definitive diagnosis because the clinical features of eosinophilic panniculitis may easily be confused with Kaposi's sarcoma.

NIH/BioMed

Reactive Oxygen Species (ROS) are Induced by Kaposi's Sarcoma-Associated Herpesvirus Early During Primary Infection of Endothelial Cells to Promote Virus Entry.

Nov 2012

Bottero V, Chakraborty S, 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.

Abstract

KSHV entry into human dermal microvascular endothelial cells (HMVEC-d), a natural in vivo target cell, via macropinocytosis is initiated through a multistep process involving binding of KSHV envelope glycoproteins with cell surface α3β1, αVβ3 and αVβ5 integrin molecules and tyrosine kinase EphrinA2 receptor followed by the activation of integrin-associated pre-existing signaling molecules such as FAK, Src, c-Cbl, PI3-K and Rho-GTPases. Many viruses, including KSHV, utilize cellular reactive oxygen species (ROS) for viral genomic replication and survival within host cells; however, the role of ROS on early events of viral entry and induction of signaling has not been elucidated. Here we show that KSHV induced ROS production very early during infection of HMVEC-d cells which was sustained over the observed 24 h post-infection. ROS induction was dependent on KSHV binding to the target cells since pretreatment of virus with heparin abolished ROS induction. Pretreatment of HMVEC-d cells with the antioxidant N-Acetyl-Cysteine (NAC) significantly inhibited KSHV entry and consequently gene expression without affecting virus binding. In contrast, H(2)O(2) treatment increased KSHV entry and infection. In addition, NAC inhibited KSHV infection induced translocation of αVβ3 integrin into lipid rafts, actin dependent membrane perturbations such as blebs observed during macropinocytosis and activation of EphrinA2 receptor, FAK, Src and Rac1 signal molecules. In contrast, H(2)O(2) treatment increased the activation of EphrinA2, FAK, Src and Rac1. These studies demonstrate that KSHV infection induces ROS very early during infection to amplify the signaling pathways necessary for its efficient entry via macropinocytosis in HMVEC-d cells.

PubMed

Sirolimus for the treatment of kaposi sarcoma after renal transplantation: a series of 10 cases.

Nov 2012

Yaich S, Charfeddine K, Zaghdane S, El Aoud N, Jarraya F, Kharrat M, Hachicha J.

Source

Department of Nephrology, Hedi Chaker Hospital, Sfax, Tunisia.

Abstract

The incidence of Kaposi sarcoma (KS) has substantially increased among immunocompromised patients, suggesting a role for immunosuppressive drugs. The aim of this study was to evaluate the incidence, features, and outcome of KS among 307 kidney transplantation patients at our center between January 1994 and June 2010. During the study period, the 10 patients who developed KS (3.25%) showed a mean age at transplantation of 35.8 ± 8.7 years (range, 22 to 49 years). The mean interval between transplantation and occurrence of KS was 24.7 ± 21.36 months (range, 6 to 64 months). The mean time of antithymocyte globulin induction was 9.5 days (range, 6 to 13 days). KS was restricted to the skin in 7 cases, among which, one presented with associated Hodgkin lymphoma. Visceral involvement (one lung and one colon) was observed in two cases. One patient presented with a gastric KS without skin lesions. Immunosuppressive treatment was reduced, then withdrawn in three cases, resulting in regression of KS a few weeks later, but with graft loss requiring hemodialysis at 1, 3 and 4 months. Among the remaining 7 cases, we stopped mycophenalate mofetil (MMF) and switched from calcineurin inhibitors to sirolimus. Allograft function remained stable after the switch. Only one patient who already had allograft dysfunction due to biopsy-proven chronic allograft nephropathy. Deteriorated progressively, undergoing hemodialysis at 2 years after KS diagnosis. In conclusion, we observed a relatively high incidence of KS among our cases. The introduction of sirolimus resulted in complete regression of KS lesions with preserved graft function.

Transplantation Proceedings

Fine-needle cytology of Kaposi's sarcoma in an intramammary lymphnode: report of one case.

Aug 2012

Fulciniti F, De Chiara A, Apice G, Petrillo A, Botti G, Feroce F, Mozzillo N.

Source

S.S.D. di Citopatologia, A.F. di Anatomia Patologica e Citopatologia, Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy. f.fulciniti@istitutotumori.na.it

Abstract

Kaposi's sarcoma (KS) is the most common human immunodeficiency virus (HIV) infection disease-associated malignancy. It consists of an angiosarcomatous change of the epithelial and mucous membrane-associated connective tissue not only in various sites, for example, skin, gastrointestinal system, lungs, and so on, but may also involve nonepithelial organs, such as lymph nodes. An unusual localization of KS to an intramammary lymphnode is reported here. The patient, an HIV-negative 69-year-old woman with a clinical history of rheumatoid arthritis treated with hydrocortisone, had an 8-month pathological history of biopsy-proven Kaposi sarcoma of the skin with visceral extension (stomach and duodenum). The appearance of a well-defined 23 × 20 mm(2) breast nodule during chemotherapy elicited fine-needle cytology to exclude breast carcinoma. Surgical excision confirmed the cytopathological diagnosis of Kaposis's sarcoma.

Wiley Online Library

For the Future Studies of Kaposi’s Sarcoma-Associated Herpesvirus

2012

Keiji Ueda

It is 18 years since Kaposi’s sarcoma-associated virus (KSHV), also called human herpesvirus 8 (HHV-8), was found from Kaposis’ sarcoma (KS) by Chang et al. (1994). More than 8, 000 reports have been published so far and we have learned many things from this virus. I would like to say it is about time to look back previous studies and to think what to study next on the virus, and planed a topic to think what to study next on the virus for future.

Herpesviruses have relatively big genomes and encode a 100 genes or so. Thus, the virion assembly/structure, gene expression regulation and attachment/entry are complicated and have known only an iceberg of them. Studying the details how the viruses run their life cycles and cause diseases in their processes will lead to exploring new therapeutic drugs/methods.

A viral life cycle starts from attachment on the susceptible cells and then, entry into the cells, followed by the viral gene expression, the genome replication, the particle assembly and finally the daughter viruses egress out of the cells. This process is skillfully built and all the viral genes are required for the process, though there are essential genes and non-essential ones. Viral pathogenesis could be established during this process by the interaction between viruses and host cells, and individual host systems such as immune system. In this topic, although I would like to cover all the processes, thankfully, 15 specialists in each field have contributed for this topic.

see full text article:  NIH

Disseminated cutaneous Kaposi sarcoma in a patient receiving triptolide/tripdiolide for rheumatoid arthritis.

Aug  2012

Grzegorzewska AE, Frankiewicz D, Bręborowicz D, Matławska I, Bylka W.

Source

Chair and Department of Nephrology, Transplantology and Internal Diseases, Karol Marcinkowski University of Medical Sciences, Poznan, Poland. alicja_grzegorzewska@yahoo.com

Abstract

BACKGROUND:

To date, Kaposi sarcoma has not been mentioned among the adverse effects of triptolide/tripdiolide, ethyl acetate extracts or polyglycosides of the Chinese herbal remedy Tripterygium wilfordii Hook F.

CASE REPORT:

A patient was diagnosed with rheumatoid arthritis at the age of 29 years. She underwent treatment with corticosteroids, methotrexate and gold sodium thiosulfate, and was chronically taking ketoprofen. At the age of 59 years she started to take a powder (≈2 g/day) from a Chinese physician for treatment of rheumatoid arthritis. This powder was supplied to her regularly for 10 years. At the age of 69 years, multiple soft, violaceous to dark-red patches, plaques, nodules and blisters of varying sizes appeared on a background of severely edematous skin on her legs, and later on her arms. Biopsy specimens of the leg lesions were diagnostic for human herpesvirus 8-associated Kaposi sarcoma. Triptolide (235 µg/1 g) and tripdiolide were found in the Chinese powder by the use of Liquid Chromatography Electrospray Ionization Mass Spectrometry. Administration of the powder was stopped and medication with paclitaxel was introduced. General condition of the patient improved and skin lesions diminished significantly.

CONCLUSIONS:

This case indicates a possible association between triptolide/tripdiolide chronic intake and development of human herpesvirus 8-associated Kaposi sarcoma. Triptolide/tripdiolide could contribute to development of Kaposi sarcoma by reactivation of latent human herpesvirus 8, permitted by immunosuppression induced by triptolide.

PubMed

AIDS-related Gastrointestinal Kaposi Sarcoma in Korea: A Case Report and Review of the Literature.

Sept 2012

Chung CY, Park SW, Myung E, Cho DK, Song YA, Park KJ, Jang HC, Joo YE.

Source

Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-dong, Dong-ku, Gwangju 501-757, Korea.

Abstract

Kaposi sarcoma (KS) is a vascular neoplasm, which is fairly prevalent in acquired immunodeficiency syndrome (AIDS) patients. Mucocutaneous and lymph node involvements are characteristic features of KS in AIDS patients. The involvement of gastrointestinal tract occurs in 40% of KS patients and leads to significant morbidity and mortality. In the highly active antiretroviral therapy (HAART) era, the rate of AIDS related KS has fallen with control of human immunodeficiency virus (HIV) viremia. However, it is still recognized as the primary AIDS-defining illness, and the proportion of AIDS diagnoses made due to KS ranged from 4.1% to 7.5%. In Korea, AIDS-related KS has been report in low rate incidence. Its gastrointestinal involvements are rarely reported. To date, five cases have been recorded in Korea. Herein, we present an additional case of gastrointestinal KS as the AIDS-defining illness and review of the Korean medical literature. (Korean J Gastroenterol 2012;60:166-171).

KJG

Oral HIV-Associated Kaposi Sarcoma: A Clinical Study from the Ga-Rankuwa Area, South Africa.

2012

Khammissa RA, Pantanowitz L, Feller L.

Source

Department of Periodontology and Oral Medicine, University of Limpopo, Medunsa Campus, Pretoria 0204, South Africa.

Abstract

Background. Kaposi sarcoma (KS) is one of the most common neoplasms diagnosed in HIV-seropositive subjects. Oral involvement is frequent and is associated with a poor prognosis. The aim of this study was to characterize the features of oral HIV-KS in patients from Ga-Rankuwa, South Africa. 

Methods. All cases with confirmed oral HIV-KS treated at the oral medicine clinic in Ga-Rankuwa from 2004 to 2010 were included in this retrospective study. Differences between males and females with oral HIV-KS in relation to HIV infection status, to oral KS presentation and to survival rates were statistically analysed. 

Results. Twenty (54%) of the 37 patients in the study were females and 17 (46%) were males. In 21 patients (57%), the initial presentation of HIV-KS was in the mouth. Other than the fact that females presented with larger (≥10 mm) oral KS lesions (P = 0.0004), there were no statistically significant gender differences. Significantly more patients presented with multiple oral HIV-KS lesions than with single lesions (P = 0.0003). Nine patients (24%) developed concomitant facial lymphoedema, and these patients had a significantly lower CD4+ T-cell count (28 cells/mm(3)) compared to the rest of the group (130 cells/mm(3)) (P = 0.01). The average CD4+ T-cell count of the patients who died (64 cells/mm(3)) was significantly lower (P = 0.0004), there were no statistically significant gender differences. Significantly more patients presented with multiple oral HIV-KS lesions than with single lesions (P = 0.016) at the time of oral-KS presentation than of those who survived (166  cells/mm(3)). 

CONCLUSIONS: In Ga-Rankuwa, South Africa where HIV-KS is prevalent, oral KS affects similarly males and females. A low CD4+ T-cell count at the time of oral HIV-KS diagnosis and the development of facial lymphoedema during the course of HIV-KS disease portends a poor prognosis.

NIH

Pulmonary kaposi sarcoma in AIDS.

October 2012

Sumedh S. Hoskote, MD AFFILIATIONS  Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY , Vishal P. Patel, DO Division of Pulmonary, Critical Care and Sleep Medicine Columbia University College of Physicians and Surgeons, New York, NY

A 34-year-old man presented to the hospital with a productive cough, dyspnea, subjective fever, chills, and myalgias. Fever, tachycardia, tachypnea, and severe hypoxemia were noted on arrival. Examination revealed a frail, diaphoretic man in considerable respiratory distress, with diffuse bilateral rales and rhonchi; a violaceous, raised rash over the limbs and trunk was also noted. Findings on chest radiography were suggestive of multilobar pneumonia. A rapid oral antibody test for human immunodeficiency virus (HIV) returned a positive result.

Computed tomography of the chest showed striking flame-shaped opacities and spicular thickening of the bronchovascular bundles in all lobes (panels A, B, and C, arrows). These findings are characteristic of pulmonary Kaposi sarcoma (KS).¹ In our patient, the diagnosis was confirmed by bronchoscopy and skin biopsy. Computed tomographic features of KS are extremely helpful in guiding the initial management of HIV-infected patients presenting with symptoms of pneumonia.

Mayo Clinic