Spurious Presentation of Pulmonary Kaposi Sarcoma as Unresolved Pneumonia Led to Fatal Outcome

Abstract

Acquired immunodeficiency syndrome (AIDS)-associated Kaposi sarcoma (KS) is an angioproliferative neoplasia caused by infection with human herpesvirus 8 (HHV-8). It typically presents with mucocutaneous involvement, but it can be disseminated. Initial presentation with primarily pulmonary KS is rare. We present a case of a 32-year-old male with untreated human immunodeficiency virus (HIV) diagnosed 1 year before presentation who developed progressively worsening cough and shortness of breath for 6 months. He was hospitalized twice and treated for unresolved pneumonia in an outside hospital. The patient concomitantly developed purplish nodules on his face, then the upper trunk, back, chest, and thighs bilaterally that gradually increased in size and number. Histopathology findings from skin lesions were consistent for KS. Bronchoscopy found multiple erythematous plaques throughout the tracheobronchial tree with telangiectasias and inflammation suggestive of pulmonary KS. His imaging findings and positive serum HHV-8 polymerase chain reaction (PCR) were consistent with disseminated KS. He started antiretroviral therapy (ART) to treat his HIV infection, followed by liposomal doxorubicin chemotherapy. But both ART and chemotherapy were interrupted due to adherence and insurance issues. The patient was readmitted with acute respiratory failure requiring mechanical ventilation with multiple vasopressors that led to the patient's demise. The late recognition of KS diagnosis and delayed treatment can lead to worse outcomes.

Keywords: AIDS associated KS; Disseminated KS; HHV-8; Kaposi sarcoma.

Figure1.

(A) Indurated non-pruritic purplish plaques on the medial aspect of thighs. (B) Erythematous mucous plaques discovered on bronchoscopy in the endobronchial area. (C) Histopathology of cutaneous skin lesion from the thigh showing endothelial cells stained immunohistochemically with diaminobenzidine anti-CD31 stain (10×). (D) Nuclear staining with HHV-8 stain (10×) from the thigh lesion biopsy. Abbreviations: HHV-8, human herpesvirus 8; CD31, cluster of differentiation 31.

Figure 2.

(A) CT chest indicating bilateral pleural effusion and scattered ground glass opacities. (B) Worsening ground glass opacities and alveolar infiltration on second hospitalization. (C) Left upper renal pole 1 cm hypodensity. (D) Subtle hepatic hypodensities worse in left hepatic lobe suggestive of disseminated KS. Abbreviations: CT, computed tomography; KS, Kaposi sarcoma.