A 56 y.o. male presents with painful arm swelling and a rash

What is wrong?

Our patient had Kaposi’s sarcoma.  The epidemic type (which he had) was more common among the HIV positive patients prior to good antiretroviral therapy.

It is also found in other immunosuppressed patients often after a transplant and in all cases is related to Herpesvirus 8.  As in our patient, the disease can be widely disseminated. Our patient had Kaposi’s of the lung as well causing left lower lobe collapse. He had tumor of the L chest wall and marked lymphadenopathy in posterior mediastinum and inguinal region.

Involvement of the lung caused LLL collapse

Although it is called a sarcoma, it does not arise from mesenchymal tissue and is thought to be a cancer of the lymphatic endothelium.  It forms vascular channels that fill with blood and cause the purplish lesions visible on the skin. The diagnosis is made by biopsy and the presence of KSHV protein LANA.

Kaposi’s can be nodular or flat as appears on this image

Treatment is based on the sub-type, and the person’s immune function.  HAART suppresses Kaposi’s in 40% of AIDS associated Kaposi’s, but a number of people will have recurrence of the lesions after years on HAART.

Our patient remains on HAART and is free of the skin lesions, although the LLL collapse never improved. 

Untreated Kaposi’s becomes nodular

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Qunibi W, Al-Furayh O, Almeshari K, et al. Serologic association of humnan herpesvirus eight with posttransplant Kaposi’s sarcoma in Saudi Arabia. Transplantation 65(4):583-5.

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