Kaposi's sarcoma — Clinical Case (Wikimedia Commons)

Diagnosis: Kaposi's sarcoma

This brown cutaneous nodule represents a Kaposi's sarcoma lesion commonly found in patients with AIDS. Before the onset of the AIDS pandemic, Kaposi’s sarcoma was an uncommon malignancy found mainly a. Clinical photograph sourced from Wikimedia Commons (Public domain). Attribution: Photo Credit: Content Providers: CDC/ Dr. Steve Kraus.

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