Kaposi's sarcoma — Clinical Case (Wikimedia Commons)

Diagnosis: Kaposi's sarcoma

This HIV-positive patient presented with an intraoral Kaposi’s sarcoma lesion with an overlying candidiasis infection. This AIDS patient exhibited a CD4+ T-cell count 200, and a high viral load. I. Clinical photograph sourced from Wikimedia Commons (Public domain). Attribution: Photo Credit: Sol Silverman, Jr., D.D.S. Content Providers: CDC/ Sol Silverman, Jr., D.D.S., University of California, San Francisco.

Clinical Presentation

Violaceous to dark brown-black macules, papules, plaques, and nodules. May follow Langer's lines. Can involve skin, oral mucosa, lymph nodes, and viscera (GI, lungs). AIDS-associated KS often widespread and rapidly progressive.

Clinical History

Classic: elderly men of Mediterranean/Eastern European descent. AIDS-associated: declining with antiretroviral therapy. Iatrogenic: organ transplant recipients. HHV-8 seroprevalence varies geographically. Check HIV status in all patients with KS.

Treatment

AIDS-KS: antiretroviral therapy (immune reconstitution). Localized: radiation, cryotherapy, intralesional vinblastine, topical alitretinoin. Widespread/visceral: liposomal doxorubicin, paclitaxel, immunotherapy (pembrolizumab). Iatrogenic: reduce immunosuppression.

Differential Diagnosis

Bacillary angiomatosis, Angiosarcoma, Pyogenic granuloma, Dermatofibroma, Melanoma, Stasis dermatitis

Key Learnings

Initiation of ART may cause KS-IRIS (immune reconstitution inflammatory syndrome) with paradoxical worsening. Bacillary angiomatosis (Bartonella) can mimic KS in HIV patients — biopsy essential. HHV-8 serology helps confirm diagnosis.

Tags: Kaposi sarcoma, HHV-8, vascular, neoplasm, AIDS-related