Rare, disseminated Kaposi sarcoma in advanced HIV with high-burden pulmonary and skeletal involvement

Abstract

We describe the case of a 30-year-old man who presented to our institution with hypoxia and widespread pulmonary infiltrates managed initially as COVID-19 before receiving a new diagnosis of HIV-associated Kaposi sarcoma (KS) with widespread pulmonary and skeletal involvement. Initial differential diagnoses included Pneumocystis jirovecii pneumonia, disseminated mycobacterial infection and bacillary angiomatosis. A bone marrow biopsy showed heavy infiltration by spindle cells, staining strongly positive for human herpes virus-8 (HHV-8) and CD34, suggesting symptomatic, disseminated KS as the unifying diagnosis. The patient commenced cytotoxic therapy with weekly paclitaxel, with a clinical and radiological response. To our knowledge, this case is among the most severe described in the literature, which we discuss, along with how COVID-19 initially hindered developing a therapeutic allegiance with the patient.

Keywords: COVID-19; HIV / AIDS; cancer - see oncology; cancer intervention; infections.

Figure 1

Images obtained from initial CT of patient’s thorax, abdomen and pelvis on admission, indicating pulmonary parenchymal disease in (A) transverse section, and disseminated osseous disease involving the axial skeleton in sagittal section. Subsequently staining strongly positive for (B) HHV-8 and (C) CD34.

Figure 2

Images obtained from the stained histology slides of bone biopsy taken from the patient, indicating spindle cell proliferation and lymphoid aggregates infiltrating the bone on hematoxylin and eosin (H&E) staining (A), subsequently staining strongly positive for (B) HHV-8 and (C) CD34.

Figure 3

Comparative CT scans of our patient’s lung fields at (A) point of diagnosis and (B) 11 months later following chemotherapy and immune reconstitution.