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.

Regression of conjunctival tumor during dietary treatment of celiac disease.

A 3-year-old girl presented with a hemorrhagic conjunctival lesion in the right eye. The medical history revealed premature cessation of breast feeding, intolerance to the ingestion of baby foods, anorexia, and abdominal distention. Prior to her referral, endoscopic small intestinal biopsy had been carried out under general anesthesia with a possible diagnosis of Celiac Disease (CD). Her parents did not want their child to undergo general anesthesia for the second time for the excisional biopsy. We decided to follow the patient until all systemic investigations were concluded. In evaluation, the case was diagnosed with CD and the conjunctival tumor showed complete regression during gluten-free dietary treatment. The clinical fleshy appearance of the lesion with spider-like vascular extensions and subconjunctival hemorrhagic spots, possible association with an acquired immune system dysfunction due to CD, and spontaneous regression by a gluten-free diet led us to make a presumed diagnosis of conjunctival Kaposi sarcoma.