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

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