A case of acquired immunodeficiency syndrome-related Kaposi sarcoma in a patient with COVID-19 - A brief review of HIV-COVID Co-infection and its Therapeutic challenges!

Abstract

Barriers posed by the COVID-19 pandemic have led to reduced access to Human Immunodeficiency virus (HIV) care, leaving untreated patients at risk for various superimposed infections and malignancies such as Kaposi sarcoma (KS). We recently encountered a 37-year-old African-American male with a past medical history of HIV who tested positive for SARS-CoV-2 and was diagnosed with AIDS-related disseminated KS, representing the first reported case of COVID-19 infection with a newly diagnosed concomitant KS. The patient experienced multi-organ failure requiring tracheostomy, renal replacement therapy, and a prolonged intensive care unit (ICU) stay. Goals of care were changed to comfort measures and the patient passed away shortly afterwards. He was made comfort measures and passed away shortly afterwards. AIDS-related KS is a vascular tumor seen in association with Human Herpes Virus-8 (HHV-8). Management of limited AIDS-related KS typically includes combined antiretroviral therapy (ART) while multi-organ KS disease demands systemic chemotherapy. Immunosuppression should be avoided in patients with AIDS-related KS as it can lead to progression of KS. This recommendation is in conflict with the usual standard of care for patients with COVID-19 pneumonia, requiring clinical judgment and a customized approach based on the stage and severity of both the KS and the COVID-related disease. We briefly review HIV-COVID-19 coinfection, AIDS related KS and challenges associated with their management.

Keywords: COVID-19; HHV-8; HIV; Kaposi sarcoma; Social inequities.

Fig. 1

Multiple scattered red violaceous macules and papules seen on back (Panel A) and front of chest (Panel B). Pertinent laboratory workup at admission is summarized in Table 1. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 2

Bilateral lower lobe consolidations and ground glass opacities (Panel A); peribronchovascular consolidations and bronchial thickening (Panel B).

Fig. 3

Multiple hypodense lesions are noted in liver parenchyma.

Fig. 4

Hematoxylin and eosin stain shows proliferating spindled nuclear morphology cells surrounding an irregular dermal proliferation of slit-like vascular spaces (Panel A). Immunohistochemical stain shows HHV-8 positive cells (Panel B).

Fig. 5

Flat elongated violaceous mucosal lesion in right mainstem bronchus (marked by blue arrow) suggestive of KS. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)