A 41-year-old man was admitted to the hospital for significant weight loss and anaemia. He was noted to have dark brownish lesions over bilateral lower limbs. The skin lesions first appeared 4 months ago and were asymptomatic.
On examination, the patient appeared wasted and malnourished. There was low-grade fever. Multiple hyperpigmented macules and papules were noted over bilateral legs and soles. There were no ulcers. Regional lymph nodes were not enlarged.
Diagnosis
Kaposi’s sarcoma
A skin biopsy of the lesion on the left shin revealed nodular aggregates of spindle cell tumor in the dermis with positive staining for human herpes virus type 8 (HHV8). The histological findings were consistent with a diagnosis of Kaposi’s sacroma. The patient consented for HIV testing and serology was positive for HIV-1 antibodies. CD4+ count was found to be 4 x 109 /L. Later, he was also diagnosed to have oral and esophageal candidiasis and CMV colitis.
Kaposi’s sarcoma (KS) is a malignant vascular tumor associated with HHV8. Four clinical subtypes are recognized:
- Classic, chronic KS
- African-endemic KS
- Iatrogenic immunosuppression-associated KS
- Acquired immunodeficiency syndrome (AIDS) associated KS. Kaposi’s sarcomas often begin as asymptomatic violaceous ecchymotic macules and later progress to more readily notable papulonodules. In AIDS-associated KS, rapid disease progression and metastasis are related to low CD4+ count. Pulmonary and intestinal metastases are common.
Management
Highly active antiretroviral therapy (HAART) is recommended for all patients with AIDS-related KS. It is evident that KS-related mortality improved substantially in patients receiving HAART. In addition, AIDS-associated KS usually responds to palliative local therapies. Radiotherapy, cryotherapy, electrodessication and surgical excision are indicated for cosmetic disfigurement or recurrent bleeding. Systemic chemotherapy therapy is reserved for more extensive disease but may result in further compromise of the immune system and should be avoided whenever possible.