Sarcoma de Kaposi, sífilis e neurocriptococose em paciente HIV positivo / Kaposi's sarcoma, syphilis and neurocryptococcosis in an HIV-positive patient

A infecção pelo vírus da imunodeficiência humana (HIV) tornou-se um problema de saúde pública em todo o mun-do nas últimas décadas. A principal característica do HIV é a supressão do sistema imunológico pelo ataque aos linfócitos T CD4+ que enfraquece o sistema imunológico e torna o indivíduo suscetível a infecções oportunistas, neoplasias secundárias e doenças neurológicas. Este estudo objetiva relatar e discutir o caso de um paciente HIV positivo que apresentou concomitantemente Sarcoma de Kaposi (SK), sífilis e neurocriptococose, todas doenças relacionadas ao HIV. Trata-se de um paciente masculino, 31 anos, que procurou o serviço do hospital de referência com lesões cutâneas violáceas em face, membros superiores e tórax, com três meses de evolução. Ao exame dermatológico exibiu placas eritematovioláceas infiltrativas, com bordas regulares, elevadas, descamativas e com diâmetros variáveis. Obteve sorologia positiva para anticorpos anti-HIV e VDRL, iniciando protocolos de terapia antirretroviral (TARV) e de tratamento para sífilis. O paciente retornou ao serviço 30 dias após alta hospitalar, com queixa de cefaleia de forte intensidade, refratária à analgesia com opioides, associada a vômitos persistentes. Re-alizada tomografia computadorizada de crânio, sem alterações, e, posteriormente, punção liquórica que evidenciou a presença de criptococo. Iniciado esquema terapêutico para neurocriptococose e realizadas outras duas punções liquóricas para alívio do quadro álgico. Este relato está de acordo com o que presume a literatura médica, reafirmando que pacientes HIV positivos apresentam maior predisposição para condições como o SK, a sífilis e a neurocriptococose. Dessa forma, o estudo ilustra com ineditismo a ocorrência simultânea de complexas manifestações clínicas no mesmo paciente imunossuprimido (AU).

Human immunodeficiency virus (HIV) infection has become a worldwide public health problem in recent decades. The main characteristic of HIV is the suppression of the immune system by attacking CD4+ T lymphocytes, which weakens the immune system and makes the individual susceptible to opportunistic infections, secondary neoplasms, and neurological diseases. This study aims to report and discuss the case of an HIV-positive patient who presented concomitantly Kaposi's Sarcoma (KS), primary syphilis, and neurocryptococcosis, all HIV-related. This is a 31-year-old male patient who sought care at the reference hospital with violaceous skin lesions on the face, upper limbs and chest, with a three-month evolution. Dermatological examination showed infiltrative erythematous-violet plaques, with regular, elevated, scaly edges and varying diameters. He obtained positive serology for anti-HIV and VDRL antibodies, initiating antiretroviral therapy (ART) and treatment protocols for primary syphilis. The patient re-turned to the service 30 days after hospital discharge, complaining of severe headache, refractory to analgesia with opioids, associated with persistent vomiting. Cranial computed tomography was performed and did not demonstrate alterations; later CSF puncture showed the presence of cryptococcus. A therapeutic scheme for neurocryptococcosis was started, and two other CSF punctures were performed to relieve the pain. This report agrees with the medical literature, reaffirming that HIV-positive patients present a greater predisposition to conditions such as KS, syphilis, and neurocryptococcosis. Thus, the study illustrates with uniqueness the simultaneous occurrence of complex clinical manifestations in the same immunosuppressed patient (AU),

Survival of patients living with HIV and cancer in Cali, Colombia

Background: People living with HIV have an increased risk of cancer compared to the general population. However, with the increase in life expectancy and advances in antiretroviral therapy, the survival of patients with cancer and HIV has changed. Objective: To determine the survival of patients living with HIV and cancer in Cali, Colombia Methods: A retrospective cohort study was conducted at the Fundación Valle del Lili, Cali, Colombia. Data from the HIV database was crossed with data from the hospital and population-based cancer registries between 2011-2019. Patients <18 years, limited available clinical information on the diagnosis and treatment of HIV and cancer, and non-oncological tumor diagnosis were excluded. Results: A total of 173 patients were included. The frequencies of AIDS-defining neoplasms were: Non-Hodgkin lymphoma (42.8%), Kaposi sarcoma (27.8%), and cervical cancer (4.6%). Overall survival was 76.4% (95% CI 68.9-82.3) at five years. Poorer survival was found in patients with AIDS-defining infections (56.9% vs. 77.8%, p=0.027) and non-AIDS-defining infections (57.8% vs. 84.2%, p=0.013), while there was better survival in patients who received antiretroviral therapy (65.9% vs. 17.9%, p=0.021) and oncological treatment (66.7% vs. 35.4%, p<0.001). The presence of non-AIDS-defining infections increases the risk of dying (HR = 2.39, 95% CI 1.05-5.46, p=0.038), while oncological treatment decreases it (HR = 0.33, 95% CI 0.14-0.80, p=0.014). Conclusions: In people living with HIV, Non-Hodgkin lymphoma and Kaposi sarcoma are the most common neoplasms. Factors such as AIDS-associated and non-AIDS-associated infections have been identified as determinants of survival. Cancer treatment seems to improve survival.

Antecedentes: Las personas que viven con VIH tienen un riesgo mayor de cáncer en comparación con la población general. Sin embargo, con el aumento de la esperanza de vida y los avances en la terapia antirretroviral, la supervivencia de los pacientes con cáncer y VIH ha cambiado. Objetivo: Determinar la supervivencia de los pacientes que viven con VIH y cáncer en Cali, Colombia. Métodos: Se realizó un estudio de cohorte retrospectivo en la Fundación Valle del Lili, Cali, Colombia. Los datos de la base de datos de VIH se cruzaron con los datos de los registros de cáncer de base hospitalaria y poblacional entre 2011-2019. Se excluyeron los pacientes <18 años, con información clínica limitada disponible sobre el diagnóstico y tratamiento del VIH y el cáncer y los casos con diagnóstico de tumor no oncológico. Resultados: Se incluyeron un total de 173 pacientes. Las frecuencias de neoplasias definitorias de SIDA fueron: linfoma no Hodgkin (42.8%), sarcoma de Kaposi (27.8%) y cáncer cervical (4.6%). La supervivencia global fue del 76.4% (IC 95% 68.9-82.3) a los cinco años. Se encontró una peor supervivencia en pacientes con infecciones definitorias de SIDA (56.9% vs. 77.8%, p=0.027) e infecciones no definitorias de SIDA (57.8% vs. 84.2%, p=0.013), mientras que hubo una mejor supervivencia en pacientes que recibieron terapia antirretroviral (65.9% vs. 17.9%, p=0.021) y tratamiento oncológico (66.7% vs. 35.4%, p<0.001). La presencia de infecciones no definitorias de SIDA aumentó el riesgo de morir (HR = 2.39, IC 95% 1.05-5.46, p=0.038), mientras que el tratamiento oncológico lo disminuyó (HR = 0.33, IC 95% 0.14-0.80, p=0.014). Conclusiones: En las personas que viven con VIH, el linfoma no Hodgkin y el sarcoma de Kaposi son las neoplasias más comunes. Se han identificado factores como las infecciones asociadas al SIDA y las infecciones no asociadas al SIDA como determinantes de la supervivencia. El tratamiento del cáncer parece mejorar la supervivencia.

Interrelación entre Anatomía Patológica y Dermatología ilustrada mediante un caso clínico de sarcoma de Kaposi / Illustrating the relationship between Pathological Anatomy and Dermatology by means of a clinical case of Kaposi's Sarcoma

Se presenta el caso clínico de un paciente asistido en el servicio de Dermatología por tener lesión tumoral gigante en calcáneo derecho de instauración progresiva. La biopsia incisional muestra sarcoma de Kaposi endémico sin afectación visceral. El estadio tan avanzado de la enfermedad propició la evolución tórpida del paciente. El estudio histopatológico estableció el diagnóstico certero de la lesión tumoral; la biopsia fue el método auxiliar que estableció el vínculo necesario entre el examen macroscópico y microscópico de la piel, y la interrelación básico-clínica entre dos disciplinas: Anatomía Patológica y Dermatología.

We present a clinical case of a patient seen in the Dermatology service due to a progressive giant cell tumour in the right calcaneus. Incisional biopsy shows endemic Kaposi's sarcoma without visceral involvement. The advanced stage of the disease led to the torpid evolution of the patient. The histopathological study established the accurate diagnosis of the tumour lesion, the biopsy was the auxiliary method that established the necessary link between the macroscopic and microscopic examination of the skin and the basic and clinical relationship between two disciplines: Pathological Anatomy and Dermatology.

Network pharmacology-based prediction of potential effective components of traditional Chinese medicine and their molecular mechanisms of action in the anti-angiogenic treatment of Kaposi′s sarcoma / 中华皮肤科杂志

Objective:To investigate potential effective components of traditional Chinese medicine and their molecular mechanisms of action in the anti-angiogenic treatment of Kaposi′s sarcoma based on network pharmacology, and to predict key targets and signal pathways in the anti-angiogenic treatment of Kaposi′s sarcoma with traditional Chinese medicine.Methods:According to the previous network pharmacology-based analysis results, main chemical components and targets of Rhizoma Polygoni Cuspidati, Cortex Mori, Rhizoma Smilacis Glabrae and Fructus Perillae were obtained by using the traditional Chinese medicine systems pharmacology database and analysis platform (TCMSP); potential therapeutic targets for angiogenesis and Kaposi′s sarcoma were obtained by searching the GeneCard, OMIM, DrugBank and TTD databases, and a Venn diagram was constructed to obtain targets for the interaction between Kaposi′s sarcoma and anti-angiogenic drug components; a protein-protein interaction model was constructed using the STRING 11.5 platform; the Cytoscape 3.6.0 software was used to construct the component-target visual network. Meanwhile, the Metascape platform was used to analyze the Gene Ontology (GO) functions and the enrichment of Kyoto Encyclopedia of Genes and Genome (KEGG) -based pathways. The main active ingredients and core targets obtained through the above analyses were then verified by molecular docking. Results:The core components of anti-Kaposi′s sarcoma angiogenesis drugs were resveratrol (degree: 142), quercetin (degree: 141), kaempferol (degree: 56), luteolin (degree: 56), β-sitosterol (degree: 37), arachidonic acid (degree: 36), naringenin (degree: 36), etc., and the core target was prostaglandin-endoperoxide synthase 2 (PTGS2). KEGG analysis revealed that the cancer signaling pathways were the important pathways related to the inhibiton of angiogenesis in Kaposi′s sarcoma; functional enrichment analysis showed that the positive regulation of cell migration was the most significantly enriched GO term in the biological process category. Molecular docking results showed that resveratrol, quercetin, kaempferol and luteolin had good affinity with PTGS2, especially quercetin and luteolin exhibited the strongest binding abilities to PTGS2, with the binding energies being -9.4 and -9.5 kcal/mol, respectively.Conclusion:This study showed that the 4 traditional Chinese medicines recorded in TCMSP (including Rhizoma Polygoni Cuspidati., Cortex Mori, Rhizoma Smilacis Glabrae and Fructus Perillae) may play an anti-angiogenic role by regulating cancer signaling pathways and acting on targets such as PTGS2, and predicted the possible anti-angiogenesis mechanisms of traditional Chinese medicines in Kaposi′s sarcoma.

Sarcoma de Kaposi y trasplante renal / Kaposi's sarcoma and kidney transplantation

RESUMEN El sarcoma de Kaposi es una neoplasia maligna que afecta la piel y puede extenderse a órganos internos. Una de sus cuatro formas clínicas se denomina iatrógena o asociada a terapias inmunosupresoras empleadas en pacientes trasplantados. Su aparición se relaciona con el herpes virus 8. Se presenta un paciente masculino de 62 años de edad de piel mestiza, con enfermedad renal crónica estadio 5 de etiología no filiada e hipertensión arterial secundaria ligera y controlada con monoterapia. Recibió trasplante renal de donador cadavérico 18 meses antes con función limítrofe. Durante su ingreso en el contexto de un cuadro diarreico agudo por Cryptosporidium parvum, se detectó una lesión que le confería sensación dolorosa progresiva, que ganó en extensión con el transcurso de los días. El diagnóstico anatomopatológico fue compatible con sarcoma de Kaposi en forma de placa.

ABSTRACT Kaposi's sarcoma is a malignant neoplasm that affects the skin and can spread to internal organs. One of its four clinical forms is called iatrogenic or associated with immunosuppressive therapies used in transplant recipients. Its occurrence is related to herpesvirus 8. We present a 62-year-old mixed-race male patient with stage 5 chronic kidney disease of unknown aetiology and mild secondary arterial hypertension controlled with monotherapy. He received a kidney transplant from a cadaveric donor 18 months earlier with borderline function. During his admission in the context of acute diarrhoea caused by Cryptosporidium parvum, a lesion was detected that gave him a progressive painful sensation, which increased in extent over the course of the days. The anatomopathological diagnosis was compatible with the plaque form of Kaposi's sarcoma.

Mechanism and immunotherapy of Kaposi sarcoma-associated herpesvirus and host immunity in the pathogenesis of Kaposi sarcoma / 国际肿瘤学杂志

Kaposi sarcoma is a multiple pigmented hemangioma of soft tissue. The etiology of Kaposi sarcoma is still unclear. Its occurrence is related to Kaposi sarcoma-related herpesvirus. Kaposi sarcoma-associated herpes virus plays an important role in the occurrence and development of Kaposi sarcoma by interfering with the pattern recognition receptors, complement system, or effecting on the immune cells directly to evasive host immune system. The immune modulators, immunotherapy of targeted drugs and vaccines are expected to be the new methods for the prevention and treatment of Kaposi sarcoma.

Etiopathogenic, epidemiologic and clinical-therapeutic comparison of non-hodgkins lymphoma and kaposis sarcoma / Comparação etiopatogênica, epidemiológica e clinicoterapêutica de linfoma não hodgkin e sarcoma de kaposi

ABSTRACT Background: Non-Hodgkin's lymphomas (NHL) are primary neoplasms derived from lymphocytes, and Kaposi's sarcoma (SK) is a multicentric disease of viral etiology and is associated with HIV. Aim: To study the etiopathogenesis and clinical characteristics of NHL and KS, describing their mutual factors. Methods: This retrospective investigation was performed on 101 medical charts. The patients were studied according to their age, gender, and HIV-positivity, following the PRISMA guidelines. The characteristics of the tumors and comorbidities were analyzed according to their age and lymphatic metastasis. Results: The mean age of the patients ranged between 15-87 years for NHL and between 25-54 for KS, but the age of patients with NHL associated with HIV did not surpass 34 years. The ratio male: female was 1,8:1 for NHL, but only men presented KS. HIV-positivity was found in five patients with NHL and in 14 with KS. The stages of NHL were: I (21%), II (18,4%), III (26,3%), and IV (34,2%), but KS were found only at III (40%) and IV (60%) stages. The lymphatic metastases were positive in 62 patients NHL and in four with KS. HIV-positivity occurred in 60% of patients with NHL and in 50% with KS. Conclusion: The HIV seropositivity was revealed for most of patients during the NHL and SK propaedeutic and none of them present clinical manifestations of AIDS. NHL associated with HIV was found only in young patients. NHL and KS patients have similar epidemiological, clinical, and therapeutic characteristics.

RESUMO Racional: Os linfomas não Hodgkin (LNH) são neoplasias primárias derivadas de linfócitos e o sarcoma de Kaposi (SK) é doença multicêntrica de etiologia viral, ambas associadas ao HIV. Objetivo: Avaliar características clínicas dos LNH e SK, relacionando fatores etiopatogênicos mútuos. Métodos: Foram avaliados retrospectivamente 101 prontuários. Os doentes foram analisados quanto a idade, sexo e soropositividade para o HIV, de acordo com o PRISMA guidelines. Os tumores foram classificados por estadiamento, presença de linfonodos regionais invadidos e tipo celular. Resultados: A idade variou entre 15 e 87 anos para o LNH e 25 a 54 anos para o SK, mas a idade dos pacientes com LNH associado com o HIV não ultrapassou 34 anos. A proporção homem: mulher foi de 1,8:1 para o LNH, enquanto SK foi registrado apenas em homens. A soropositividade para o HIV ocorreu em cinco pacientes com LNH e 14 com SK. A invasão de linfonodos regionais foi positiva em 62 com LNH e quatro com SK. Os linfomas foram 27,9% de baixo grau, 17,4% de grau intermediário e 12,8% de alto grau. A soropositividade para HIV, foi diagnosticada durante a propedêutica do tumor em 60% dos pacientes com LNH e 50% dos com SK. Conclusão: A maioria dos pacientes portadores de HIV descobriram a soropositividade durante propedêutica para LNH e SK, sem manifestações clínicas de AIDS. Todos os pacientes com LNH associado com o HIV eram jovens. Pacientes com LNH e com SK apresentam características epidemiológicas, clínicas e terapêuticas semelhantes entre si.

Diagnosis of elephantiasis nostras verrucosa as a clinical mani-festation of Kaposi's sarcoma / Diagnóstico de elefantiasis nostras verrucosa como mani-festación clínica del Sarcoma de Kaposi

Elephantiasis nostras verrucosa, a rare manifestation of Kaposi's sarcoma, is a progressive cutaneous hypertrophy caused by chronic non-filarial lymphedema secondary to obstruction of the lymphatic system that can lead to severe disfigurement of parts of the body that have gravity-dependent blood flow, due to edema, fibrosis, and hyperkeratosis, especially lower extremities. Among the various conditions that can induce chronic lymphedema are tumors, trauma, radiotherapy, obesity, hypothyroidism, chronic venous stasis, and AIDS-related Kaposi's sarcoma. Kaposi's sarcoma is a vascular tumor associated with the presence of human gammaherpesvirus 8 that is predominantly cutaneous, locally aggressive, with metastasis, and is associated with the production of factors that favor inflammation, lymphatic obstruction, and lymphedema.

Two cases of rare HHV8-driven intravascular lymphoma with synchronous Kaposi sarcoma, both diagnosed at autopsy in renal transplant recipients

We present the first report of two rare yet remarkably similar autopsy cases of Kaposi sarcoma (KS) and intravascular human herpesvirus 8 (HHV8) positive lymphoproliferative disorder in renal transplant patients. It is well established that HHV8 infection causes Kaposi sarcoma (KS). More recently, it is recognized that HHV8 is also related to several lymphoproliferative conditions. These are poorly characterized and often difficult to diagnose. In both cases described herein, the diagnoses of multifocal hepatic KS and intravascular HHV8 positive (EBV negative) systemic diffuse large B-cell lymphoma, NOS were made at autopsy. Given the findings we describe in cases with fatal outcomes, we discuss the implications of HHV8 screening in solid allograft recipients.

Sobrevida e Fatores Prognósticos de Pacientes com Sarcoma de Kaposi Atendidos em um Centro de Assistência de Alta Complexidade em Oncologia / Survival and Prognostic Factors of Kaposi's Sarcoma Patients Attended at a High Complexity Oncology Care Center / Supervivencia y Factores Pronósticos de Pacientes con Sarcoma de Kaposi Tratados en un Centro de Atención de Alta Complejidad en Oncología

Introdução: A sobrevida do sarcoma de Kaposi ainda não é bem conhecida porque os poucos estudos que avaliaram-na foram, em maioria, conduzidos com pessoas vivendo com vírus da imunodeficiência humana (HIV). Objetivo: Avaliar a sobrevida e os fatores prognósticos pré-tratamento de pacientes com sarcoma de Kaposi associado ou não ao HIV. Método: Estudo retrospectivo realizado em uma coorte hospitalar de 81 pacientes diagnosticados com sarcoma de Kaposi entre 2000 e 2014, atendidos em um centro de assistência de alta complexidade em oncologia da cidade do Rio de Janeiro, Brasil. A probabilidade de sobrevida em cinco anos foi estimada por meio do método de Kaplan-Meier. O modelo semiparamétrico de riscos proporcionais de Cox estimou hazard ratios (HR) e respectivos intervalos de 95% de confiança (IC95%). Resultados: A sobrevida global em cinco anos foi de 50,9% (IC95%: 38,2-62,3). Os fatores associados ao óbito foram idade ≥50 anos (HR: 4,19; IC95%: 1,5-11,29) e sorologia anti-HIV positiva (HR: 5,82; IC95%: 1,90-17,85). Conclusão:A coorte apresentou sobrevida baixa. O prognóstico foi influenciado pela idade ≥50 anos e sorologia anti-HIV positiva, devendo esses fatores serem considerados na avaliação de risco pré-tratamento.

Introduction: The survival of Kaposi's sarcoma is still not well known because the few studies that evaluated it were mostly conducted with people living with human immunodeficiency virus (HIV). Objective:To assess survival and pre-treatment prognostic factors in patients with Kaposi's sarcoma associated or not with HIV. Method: Retrospective study conducted in a hospital cohort of 81 patients diagnosed with Kaposi's sarcoma between the years 2000 and 2014 treated at a high complexity care center in oncology in the city of Rio de Janeiro, Brazil. The probability of 5-year survival was estimated using the Kaplan-Meier method. Hazard ratios (HR) and respective 95% confidence intervals (95%CI) were estimated following Cox's semi-parametric model of proportional hazards. Results:The overall 5-year survival was 50.9% (95%CI: 38.2-62.3). The factors associated with death were age ≥50 years (HR: 4.19; 95%CI: 1.5-11.29) and positive anti-HIV serology (HR: 5.82; 95%CI: 1.90-17.85). Conclusion:The cohort had low survival. The prognosis was influenced by age ≥50 years and positive anti-HIV serology, and these factors should be considered in the pre-treatment risk assessment

Introducción: La supervivencia del sarcoma de Kaposi aún no se conoce bien porque los pocos estudios que lo evaluaron se realizaron, en su mayoría, con personas que viven con el virus de inmunodeficiencia humana (VIH). Objetivo: Evaluar la supervivencia y los factores pronósticos previos al tratamiento en pacientes con sarcoma de Kaposi asociado o no con VIH. Método: Estudio retrospectivo realizado en una cohorte hospitalaria de 81 pacientes diagnosticados con sarcoma de Kaposi entre 2000 y 2014 tratados en un centro de atención oncológica de alta complejidad en la ciudad de Río de Janeiro, Brasil. La probabilidad de supervivencia a cinco años se estimó utilizando el método de Kaplan-Meier. El modelo de riesgos proporcionales semiparamétricos de Cox estimó las razones de riesgo (HR) y los respectivos intervalos de confianza del 95% (IC95%). Resultados: La tasa de supervivencia general a cinco años fue del 50,9% (IC95%: 38,2-62,3). Los factores asociados con la muerte fueron edad ≥50 años (HR: 4,19; IC95%: 1,5-11,29) y serología positiva contra el VIH (HR: 5,82; IC95%: 1,90-17,85) Conclusión: La cohorte mostró baja supervivencia. El pronóstico estuvo influenciado por la edad ≥50 años y la serología positiva contra el VIH, y estos factores deben considerarse en la evaluación de riesgos previa al tratamiento.

Extensive bulbar conjunctival Kaposi's sarcoma as initial symptom of human immunodeficiency virus / Sarcoma de Kaposi extenso na conjuntival bulbar como apresentação inicial do vírus da imunodeficiência humana

ABSTRACT Here, we present a case in which extensive bulbar conjunctival Kaposi's sarcoma was the initial presentation of human immunodeficiency virus in a 36-year-old man. The patient had a 3-month history of recurrent self-limited inferior conjunctiva hyperemia in the right eye, and presented with a painless bullous lesion in the right inferior bulbar conjunctiva persisting for 15 days. Surgical incision biopsy was performed at five locations and revealed a pattern compatible with Kaposi's sarcoma. Serologic testing was positive for human immunodeficiency virus; however, the patient had no other symptoms, or knowledge of human immunodeficiency virus infection. This case highlights the need to consider Kaposi's sarcoma as an early presentation of human immunodeficiency virus even if the patient denies infection.

RESUMO Este relato de caso apresenta um sarcoma de Kaposi extenso na conjuntival bulbar como a apresentação inicial do vírus da imunodeficiência humana em um homem de 36 anos de idade. O paciente tinha história de hiperemia na conjuntiva inferior do olho direito há 3 meses, autolimitada e recorrente e de surgimento de uma lesão bolhosa indolor no mesmo local 15 dias antes da sua apresentação. Uma biópsia incisional cirúrgica foi realizada e revelou um padrão compatível com sarcoma de Kaposi. Teste sorológico posterior revelou positividade para o vírus da imunodeficiência humana, no entanto, o paciente não apresentou outros sintomas, sinais ou conhecimento prévio sobre a infecção. Como conclusão deste caso, deve se ressaltar que a suspeita do diagnóstico do sarcoma de Kaposi deve ser levantada ainda que na apresentação inicial do vírus da imunodeficiência humana ou mesmo naqueles ainda sem este diagnóstico.

Clinical and endoscopic findings of patients with cutaneous Kaposi sarcoma and gastrointestinal involvement: Experience in a single center of Lima-Peru in the last 3 years / Hallazgos clínicos y endoscópicos en pacientes con sarcoma de Kaposi cutáneo y compromiso gastrointestinal: Experiencia de un centro de Lima - Perú en los últimos 3 años

Introduction: Kaposi sarcoma is a low-grade angioproliferative neoplasm strongly associated with infection by herpes virus type 8 (HHV-8). Gastrointestinal (GI) involvement is an infrequent finding, whose clinical and endoscopic characteristics are poorly defined in the literature. Objective: The aim of our study was to describe the clinical and endoscopic findings of patients with gastrointestinal Kaposi Sarcoma. Materials and methods: We reviewed all clinical histories, endoscopic and anatomopathologic reports of all patients with cutaneous Kaposi sarcoma (CKS) who came to Cayetano Heredia Gastroenterology Service during the period between August 2015 to October 2018. We included all patients with CKS that had gastrointestinal involvement confirmed with biopsy. Results: We found 50 patients with cutaneous Kaposi sarcoma. Thirteen patients had gastrointestinal Kaposi sarcoma (26%). 53.8% (7/13 cases) were asymptomatic. 92.3% (12/13 cases) had HIV infection. Nine of the twelve HIV+ patients had CD4 count below 200 cells/μl. When Kaposi affects GI tract, the mayority have multiple GI organs affected. Stomach and colon are the most common sites affected. Conclusion: Gastrointestinal involvement was presented in 26% of our patients with cutaneos Kaposi sarcoma, a half of them had no GI symptoms. The majority of cases were young male and had HIV in AIDS stage. The mortality in our series was 15.3% at 6 months of follow-up.

Introducción: El Sarcoma de Kaposi es una neoplasia angioproliferativa de bajo grado altamente asociada con la presencia del herpes virus tipo 8 (HHV-8). El compromiso gastrointestinal es un hallazgo infrecuente, cuyas características clínicas y endoscópicas son pobremente descritas en la literatura. Objetivos: El objetivo del estudio fue describir las características clínicas y endoscópicas de pacientes con Sarcoma de Kaposi gastrointestinal. Materiales y métodos: Nosotros revisamos todas las historias clínicas, reportes endoscópicos y anatomo patológicos de todos los pacientes con Sarcoma de Kaposi cutáneo que fueron al Servicio de Gastroenterología del Hospital Cayetano Heredia durante el periodo de Agosto del 2015 a Octubre del 2018. Se incluyeron todos los pacientes con SKC que tuvieron compromiso gastrointestinal confirmado en la biopsia. Resultados: Nosotros encontramos 50 pacientes con Sarcoma de Kaposi cutáneo. 13 pacientes tuvieron compromiso gastrointestinal (26%). 53.8% (7/13) fueron asintomáticos. 92.3% (12/13 casos) tuvieron infección con virus de VIH. Nueve de trece pacientes con VIH+ tuvieron conteos de CD4 menores de 200 cel/μl. Cuando el Kaposi afectaba el aparato digestivo, la mayoría tenía compromiso de múltiples segmentos. El estómago y el colon eran los lugares más comprometidos. Conclusión: El compromiso gastrointestinal se presentó en 26% de los pacientes con Sarcoma de Kaposi cutáneo, la mitad de ellos no tenían síntomas digestivos. La mayoría de los casos fueron varones jóvenes y tenían infección por VIH estadío SIDA. La mortalidad en nuestra serie fue 15.3% a los 6 meses de seguimiento.

Effect of viral macrophage inflammatory protein Ⅱ on the expression of APOBEC3G in 293T cells / 中华皮肤科杂志

Objective@#To assess the effect of viral macrophage inflammatory protein (vMIP) -Ⅱ on the expression of apolipoprotein B mRNA-editing enzyme-catalytic polypeptide-like 3G (APOBEC3G) , and to explore the mechanisms.@*Methods@#A recombinant plasmid pEGFP-N3-K4 (vMIP-Ⅱ plasmid group) and an empty plasmid pEGFP-N3 (empty plasmid group) were separately transfected into 293T cells, and quantitative PCR and Western blot analysis were performed to evaluate the effect of transfection with vMIP-Ⅱ gene on the APOBEC3G expression in 293T cells. Some 293T cells in the empty plasmid group and vMIP-Ⅱ plasmid group were treated with 1 000 IU/ml interferon (IFN) -α for 36 hours, and then Western blot analysis was conducted to determine the APOBEC3G expression in the empty plasmid group and vMIP-Ⅱ plasmid group with or without IFN-α treatment. Some 293T cells transfected with vMIP-Ⅱ plasmids were treated with 75 μmol/L AG490 (a JAK/STAT signaling pathway inhibitor) and 20 μmol/L U0126 (an ERK signaling pathway inhibitor) separately; after 24 hours, total protein was extracted from 293T cells, and Western blot analysis was conducted to determine the expression of APOBEC3G. A recombinant plasmid containing APOBEC3G promoter was constructed by using a luciferase reporter gene, and the promoter fragment included the full-length promoter sequence (POS) of APOBEC3G, sequences with the lengths of 1 560, 960, 720, 480, 420, 360, 330 and 240 bp, and the regulatory element-free region (NEG) of APOBEC3G, separately. Some 293T cells were co-transfected with the recombinant plasmid carrying luciferase reporter gene and vMIP-Ⅱ plasmid (experimental group), or the recombinant plasmid and empty plasmid (control group). Subsequently, the activity of the APOBEC3G promoter was evaluated, and the key promoter region through which the transcriptional activity of APOBEC3G was regulated by vMIP-Ⅱ was analyzed. Statistical analysis was carried out by using t test, one-way analysis of variance and least significant difference (LSD) -t test.@*Results@#The mRNA and protein expression of APOBEC3G was significantly higher in the vMIP-Ⅱ plasmid group (2.500 ± 0.013, 1.472 ± 0.013 respectively) than in the control group (1, 0.364 ± 0.030 respectively; t = 6.22, 6.54 respectively, both P < 0.05) . The APOBEC3G expression significantly differed among the empty plasmid group, vMIP-Ⅱ plasmid group, empty plasmid + IFN-α group and vMIP-Ⅱ plasmid + IFN-α group (1, 2.030 ± 0.108, 2.700 ± 0.081 and 2.600 ± 0.099 respectively; F = 67.026, P < 0.001) , but there was no significant difference between the vMIP-Ⅱ plasmid group and empty plasmid + IFN-α group (t = 3.46, P > 0.05) . The APOBEC3G expression also significantly differed among the vMIP-Ⅱ plasmid group, vMIP-Ⅱ plasmid + AG490 group and vMIP-Ⅱ plasmid + U0126 group (0.617 ± 0.025, 0.179 ± 0.061, 0.359 ± 0.012 respectively; F = 70.019, P < 0.001) , and was significantly lower in the vMIP-Ⅱ plasmid + AG490 group and vMIP-Ⅱ plasmid + U0126 group than in the vMIP-Ⅱ plasmid group (t = 9.66, 11.836 respectively, both P < 0.01) . Luciferase activity assay showed that the promoter activity significantly differed among the vMIP-Ⅱ plasmid groups transfected with POS, 1 560-, 960-, 720-, 480-, 420-, 360-, 330-, 240-bp or NEG sequences (F = 81.092, P < 0.001) , and the APOBEC3G promoter activity decreased greatly from the 720-bp group to 480-bp group.@*Conclusion@#vMIP-Ⅱ upregulates the expression of APOBEC3G, likely through the JAK/STAT signaling pathway or the key promoter region regulating the transcriptional activity of APOBEC3G.

Kaposi sarcoma of th e penis in anHIV-negative patient / Sarcoma de Kaposi de pênis em paciente HIV negativo

ABSTRACT Kaposi sarcoma is an angioproliferative disorder that ranges from a single indolent skin lesion to respiratory and gastrointestinal/visceral involvement. Kaposi sarcoma is rare in non-immunosuppressed patients. Nineteen cases of penile Kaposi sarcoma in HIV-negative patients were reported in 2012. We present the case report of a 48-year-old male patient with no previous medical history, who came to our urology clinic presenting a purple-color papule on the penis glans. Lab tests revealed negative serology for HIV, but tissue PCR was positive for human herpesvirus 8. Histopathology examination after lesion excision was compatible with Kaposi sarcoma. No other cutaneous or mucosal lesions were present. Primary Kaposi sarcoma of the penis is rare, but may occur in non-immunosuppressed patients.

RESUMO O sarcoma de Kaposi é uma doença angioproliferativa que varia de uma lesão cutânea indolente isolada ao envolvimento visceral respiratório e gastrintestinal. É raro em pacientes não imunossuprimidos. Dezenove casos de sarcoma de Kaposi de pênis em pacientes HIV negativos foram relatados em 2012. Descrevemos o caso de um paciente do sexo masculino, 48 anos, sem história pregressa, que se apresentou em nossa clínica urológica com pápula violeta na glande. Os testes de laboratório revelaram sorologia negativa para HIV, mas o PCR em tecido foi positivo para o herpesvírus humano 8. A histopatologia após a excisão da lesão foi compatível com sarcoma de Kaposi. Não existia outra lesão cutânea ou de mucosa. O sarcoma de Kaposi primário de pênis é raro, mas pode ocorrer em pacientes não imunossuprimidos.

Effect of viral macrophage inflammatory protein Ⅱ on the expression of APOBEC3G in 293T cells / 中华皮肤科杂志

Objective To assess the effect of viral macrophage inflammatory protein (vMIP)-Ⅱ on the expression of apolipoprotein B mRNA-editing enzyme-catalytic polypeptide-like 3G (APOBEC3G),and to explore the mechanisms.Methods A recombinant plasmid pEGFP-N3-K4 (vMIP-Ⅱ plasmid group) and an empty plasmid pEGFP-N3 (empty plasmid group) were separately transfected into 293T cells,and quantitative PCR and Western blot analysis were performed to evaluate the effect of transfection with vMIP-]Ⅱ gene on the APOBEC3G expression in 293T cells.Some 293T cells in the empty plasmid group and vMIP-Ⅱ plasmid group were treated with 1 000 IU/ml interferon (IFN)-α for 36 hours,and then Western blot analysis was conducted to determine the APOBEC3G expression in the empty plasmid group and vMIP-Ⅱ plasmid group with or without IFN-α treatment.Some 293T cells transfected with vMIP-Ⅱplasmids were treated with 75 μ mol/L AG490 (a JAK/STAT signaling pathway inhibitor) and 20 μ mol/L U0126 (an ERK signaling pathway inhibitor) separately;after 24 hours,total protein was extracted from 293T cells,and Western blot analysis was conducted to determine the expression of APOBEC3G.A recombinant plasmid containing APOBEC3G promoter was constructed by using a luciferase reporter gene,and the promoter fragment included the full-length promoter sequence (POS) of APOBEC3G,sequences with the lengths of 1 560,960,720,480,420,360,330 and 240 bp,and the regulatory element-free region (NEG) of APOBEC3G,separately.Some 293T cells were co-transfected with the recombinant plasmid carrying luciferase reporter gene and vMIP-Ⅱ plasmid (experimental group),or the recombinant plasmid and empty plasmid (control group).Subsequently,the activity of the APOBEC3G promoter was evaluated,and the key promoter region through which the transcriptional activity of APOBEC3G was regulated by vMIP -Ⅱ was analyzed.Statistical analysis was carried out by using t test,one-way analysis of variance and least significant difference (LSD)-t test.Results The mRNA and protein expression of APOBEC3G was significantly higher in the vMIP-Ⅱ plasmid group (2.500 ± 0.013,1.472 ± 0.013 respectively) than in the control group (1,0.364 ± 0.030 respectively;t =6.22,6.54 respectively,both P ＜ 0.05).The APOBEC3G expression significantly differed among the empty plasmid group,vMIP-Ⅱ plasmid group,empty plasmid + IFN-oα group and vMIP-Ⅱ plasmid + IFN-α group (1,2.030 ± 0.108,2.700 ± 0.081 and 2.600 ± 0.099 respectively;F =67.026,P ＜ 0.001),but there was no significant difference between the vMIP-Ⅱ plasmid group and empty plasmid + IFN-α group (t =3.46,P ＞ 0.05).The APOBEC3G expression also significantly differed among the vMIP-Ⅱ plasmid group,vMIP-Ⅱ plasmid + AG490 group and vMIP-Ⅱplasmid + U0126 group (0.617 ± 0.025,0.179 ± 0.061,0.359 ± 0.012 respectively;F =70.019,P ＜ 0.001),and was significantly lower in the vMIP-Ⅱ plasmid + AG490 group and vMIP-Ⅱ plasmid + U0126 group than in the vMIP-Ⅱ plasmid group (t =9.66,11.836 respectively,both P ＜ 0.01).Luciferase activity assay showed that the promoter activity significantly differed among the vMIP-Ⅱ plasmid groups transfected with POS,1 560-,960-,720-,480-,420-,360-,330-,240-bp or NEG sequences (F =81.092,P ＜ 0.001),and the APOBEC3G promoter activity decreased greatly from the 720-bp group to 480-bp group.Conclusion vMIP-Ⅱ upregulates the expression of APOBEC3G,likely through the JAK/STAT signaling pathway or the key promoter region regulating the transcriptional activity of APOBEC3G.

Sarcoma de Kaposi em paciente portador de HIV: relato de caso / Kaposi sarcoma in a patient with HIV: case report

Sarcoma de Kaposi é um tumor maligno originado do endotélio vascular que acomete principalmente pele e mucosas. Geralmente, é associado à síndrome da imunodeficiência adquirida ­ aids, apresentando lesões vinhosas, arredondadas que, com o passar dos dias, tornam-se purpúricas, elevadas e com distribuição multifocal. Nesse estudo é relatado o caso de um paciente do sexo masculino, de 42 anos de idade, de fototipo IV, com emagrecimento, diarreia, pápulas e placas eritemato-violáceas nos membros inferiores. Durante a internação, encontrou-se sorologia positiva para HIV e ao realizar histopatológico das lesões cutâneas, confirmou-se o diagnóstico de sarcoma de Kaposi. O objetivo do presente estudo é ressaltar que quando presente infecção pelo citomegalovírus em paciente com aids há maior predisposição para o desenvolvimento de tal neoplasia. (AU)

Kaposi's sarcoma is a malignant tumor originating from the vascular endothelium, which mainly affects the skin and mucous membranes. Generally, it is associated with acquired immunodeficiency syndrome - AIDS, presenting rounded, wine-like lesions that become purpuric, elevated, and multifocal in the course of days. In this study the case of a 42-year-old male phototype IV with weight loss, diarrhea, papules and erythematous-purple plaques in the lower limbs was reported. During the hospitalization, positive serology for HIV was found and the diagnosis of Kaposi's sarcoma was confirmed in the histopathological examination of cutaneous lesions. The objective of the present study is to highlight that when present with cytomegalovirus in a patient with AIDS there is a greater predisposition for the development of such neoplasia. (AU)

Sarcoma de Kaposi clásico en paciente fototipo VI. Primer reporte en Colombia / Classic Kaposi's sarcoma in phototype VI patient. First report in Colombia

Resumen El sarcoma de Kaposi es un tumor vascular de bajo grado, que afecta piel y mucosas, pudiendo comprometer ganglios linfáticos y órganos internos. Generalmente está asociado a infección por virus herpes humano 8, se clasifica en cuatro subtipos clínico-epidemiológicos, entre ellos el tipo clásico, que se manifiesta habitualmente en ancianos blancos, inmunocompetentes, de origen judío o mediterráneo. Se presenta el caso de un varón de 69 años, con fototipo VI, que desarrolló inicialmente máculas violáceas, eritematosas, de borde definido en región externa del pie izquierdo, que progresivamente se tornaron a placas y nódulos violáceos, acompañado de edema. Se realizó biopsia que mostró lesión vascular, cuya inmunohistoquímica presentó reactividad para CD30, CD34 y virus herpes humano 8, confirmando un sarcoma de Kaposi en fase de nódulo. Este caso resulta excepcional y se debe tener presente en el diagnóstico diferencial; los reportes en Suramérica son escasos, siendo este el primero en Colombia. MÉD.UIS. 2017;30(3):129-33.

Abstract Kaposi's sarcoma is a low-grade vascular tumor that affects the skin and mucous membranes and may compromise lymph nodes and internal organs. It is usually associated with human herpes virus infection 8, classified into four clinical-epidemiological subtypes, including the classical type, which is usually manifested in elderly, immunocompetent white Jews or of Mediterranean origin. We present the case of a 69-year-old male, with phototype VI, who initially developed violaceous macules, erythematous, with defined border in the external region of the left foot, which progressively turned to violet plaques and nodules, accompanied by edema. A biopsy was performed showing vascular lesion, whose immunohistochemistry presented reactivity for CD30, CD34 and human herpesvirus 8, confirming a Kaposi's sarcoma in the nodule phase. This case is exceptional and must be kept in mind in the differential diagnosis; the reports in South America are scarce, being the first in Colombia. MÉD.UIS. 2017;30(3):129-33.

Sarcoma de Kaposi variante queloidiana associada à síndrome da imunodeficiência adquirida (SIDA) / Keloidal Kaposi's sarcoma associated with acquired immunodeficiency syndrome (AIDS)

O sarcoma de Kaposi é neoplasia multicêntrica rara originária de células endoteliais com manifestação cutânea e extracutânea. Descreve-se o caso de variante clínica queloidiana de SK, incomum, em paciente do sexo masculino, de 32 anos, portador da síndrome da imunodeficiência adquirida (Aids), com regressão ao tratamento combinado de terapia antirretroviral e radioterapia.

Kaposi's sarcoma is a rare multicentric neoplasm originating from endothelial cells, with cutaneous and extracutaneous manifestation. The present paper describes a case of an uncommon clinic variant of a Kaposi's sarcoma in a 32 year-old male patient bearer of acquired immunodeficiency syndrome (AIDS), with regression after undergoing combined treatment with antiretroviral therapy and radiotherapy.

Diagnóstico diferencial de lesiones cutáneas infecciosas en paciente VIH: reporte de un caso / Differential diagnosis of infectious skin lesions in an HIV-positive patient: a case report

La infección por VIH confiere al portador la susceptibilidad para desarrollar un conjunto de infecciones que normalmente no serían encontradas en un paciente inmunocompetente. En Colombia, en el año 2015, se reportaron 11.606 casos de infección por VIH. En este escrito documentamos el caso de un paciente con diagnóstico de infección por VIH, el cual desarrolló lesiones típicas de infección por el virus Varicela Zoster, y se documentó la evolución de las lesiones vesiculares hacia flictenas con necrosis local. Dada la presentación del caso, el diagnóstico de lesiones en piel en pacientes inmunocomprometidos o con infección por VIH se convierte en un reto para el profesional de la salud a la hora de establecer un diagnóstico etiológico, a fin de establecer un adecuado tratamiento de acuerdo a este.

HIV infection makes HIV carriers susceptible to develop a group of infections that would not normally be found in an immunocompetent patient. In Colombia, a total of 11,606 cases of HIV infection were reported in 2015. This paper documents the case of a patient diagnosed with HIV infection, who developed lesions typically caused by the varicellazoster virus. These vesicular lesions evolved into phlyctenas with local necrosis. Given the case presentation, the diagnosis of skin lesions in immunocompromised or HIV-infected patients becomes a challenge for health professionals when determining an etiological diagnosis, in order to establish an appropriate treatment.

Sarcoma de Kaposi gástrico como causa inusual de sangrado digestivo / Gastric Kaposi’s sarcoma as an unusual cause of digestive bleeding

Fundamento: el sarcoma de Kaposi es un tumor de origen vascular asociado a pacientes con infección por Virus de Inmunodeficiencia Humana. Objetivo: presentar el caso de un paciente con sarcoma de Kaposi gástrico que debuta con cuadro de hemorragia digestiva. Caso Clínico: paciente masculino de 29 años que presenta cuadro de sangrado digestivo alto a forma de melena asociado a dolor abdominal en epigastrio, astenia, anorexia y pérdida de peso. Se realiza estudios complementarios que concluyen sarcoma de Kaposi gástrico en paciente HIV positivo. Conclusiones: el Sarcoma de Kaposi gástrico es una causa inusual de sangrado digestivo por lo cual constituye un hallazgo endoscópico infrecuente en pacientes sin historia personal de infección por HIV.

Background: Kaposi’s sarcoma is a vascular tumor associated with HIV infection (Human Immunodeficiency Virus). Objective: to present the case of a patient with gastric Kaposi's sarcoma who debuted with digestive hemorrhage. Clinical case: a 29-year-old male patient with upper gastrointestinal bleeding associated with abdominal pain in the epigastrium, asthenia, anorexia, and weight loss. Complementary studies were conducted which concluded Gastric Kaposi ’s sarcoma in an HIV-positive patient. Conclusions: gastric Kaposi's sarcoma is an unusual cause of digestive bleeding, making it an uncommon endoscopic finding in patients with no history of HIV infection.