Kaposi's sarcoma — Clinical Case (Wikimedia Commons)

Diagnosis: Kaposi's sarcoma

Kaposi's sarcoma. Characteristic violaceous plaques on the alar and tip of the nose in an HIV-positive female patient.. Clinical photograph sourced from Wikimedia Commons (CC BY 2.0). Attribution: M. Sand, D. Sand, C. Thrandorf, V. Paech, P. Altmeyer, F. G. Bechara.

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