Kaposi's sarcoma immune reconstitution inflammatory syndrome: A forgotten entity nowadays

Abstract

The appearance of antiviral therapy has led to a change in the prognosis and clinical manifestations of patients with human immunodeficiency virus infections and Kaposi's sarcoma. However, there are still countries in which access is inadequate and the disease progresses toward disseminated forms with an unfavorable outcome. We present two patients who presented with skin lesions that progressed for a month, compatible with disseminated Kaposi's sarcoma in the context of HIV. One month after starting treatment, they were admitted for multi-organ failure associated with an Immune reconstitution inflammatory syndrome and eventually died.

Keywords: HIV; Kaposi’s sarcoma-associated herpesvirus; SK-Immune reconstitution inflammatory syndrome.

Figure 1

Infiltrated erythematous-violaceous plaques distributed symmetrically on the trunk, and upper and lower limbs in the patient of case 1

Figure 2

Histology section corresponding to patient 1’s skin biopsy. A proliferation of small vessels in the superficial dermis can be observed, along with blood extravasation and lymphohistocytic infiltrate. The classic “prontorium sign” is present, where the walls of the vessels are dissected by the new vascular structures (H and E, ×10)

Figure 3

The histology section corresponds to a lymph node from patient 1, where destructuring of the lymph node architecture with the appearance of vascular structures is observed (H and E, ×5)

Figure 4

Immunohistochemical technique with positive Kaposi’s sarcoma-associated herpesvirus marker performed on lymph node sections

Figure 5

Chest computed tomography image of patient 1 showing pulmonary infiltrates in the setting of SK-SIRI

Figure 6

Skin lesions with similar characteristics to the previous patient, in the male of case 2