Primary Nasopharyngeal Kaposi Sarcoma as Index Diagnosis of AIDS in a Previously Healthy Man

Abstract

A 38-year-old, previously healthy man presented with blood-stained saliva and epistaxis. A 3 mm nasopharyngeal lesion was found. A biopsy was performed and microscopic examination revealed a Kaposi sarcoma. The patient was subsequently found to be positive for human immunodeficiency virus (HIV). The diagnosis of Kaposi sarcoma in the presence of HIV infection advanced his disease to Acquired Immunodeficiency Syndrome (AIDS). Primary manifestation of Kaposi sarcoma in the nasopharynx is extremely rare. The histologic differential diagnosis of Kaposi sarcoma in this unusual site, especially without the clinical history of immunosuppression, is broad. Awareness that nasopharynx can be a primary involvement site of Kaposi sarcoma and serves as index diagnosis of AIDS is important given its serious clinical implication.

Keywords: AIDS; HHV8; HIV; Kaposi sarcoma; Nasal cavity; Nasopharynx.

Fig. 1

Nasendoscopic findings show a small reddish granular mass in the left postnasal space

Fig. 2

Histologic and immunohistochemical findings of the postnasal space biopsy. a A cellular spindle cell proliferation is seen in the subepithelial stroma of the mucosa (hematoxylin and eosin, original magnification × 100). b The spindle cells show mild nuclear atypia associated with red blood cell extravasation and hyaline globules (arrows) (hematoxylin and eosin, original magnification × 200). c Immunohistochemical findings show positive nuclear staining with ERG, and d HHV-8, clinching the diagnosis of a Kaposi sarcoma (original magnification × 200)