Angiomatosis bacilar y sarcoma de Kaposi en lesión cutánea de paciente VIH positivo / Bacillary angiomatosis and Kaposi's sarcoma in skin lesion of HIV positive patient

La angiomatosis bacilar (AB) es una enfermedad infec-ciosa poco frecuente, causada por bacterias del género Bartonella spp. transmitidas por vectores como pulgas, piojos y mosquitos. En el ser humano provoca diferentes síndromes clínicos. En pacientes con infección por el virus de inmunodeficiencia humana (VIH) con recuento de LT CD4 + <100 cél/µL se asocia a lesiones angiomatosas con neovascularización que comprometen la piel y, en menor medida, mucosas, hígado, bazo y huesos.El sarcoma de Kaposi (SK) es una neoplasia caracteriza-da por hiperplasia vascular multifocal de origen endotelial relacionada con el herpes virus humano 8. También puede afectar piel, mucosas y vísceras, siendo la variante epidé-mica una enfermedad marcadora de la infección avanzada por VIH. El principal diagnóstico diferencial clínico para las lesiones cutáneas y mucosas del SK es la AB.Presentamos un paciente con enfermedad VIH/sida que desarrolló AB y SK en forma concomitante en la misma lesión cutánea

Bacillary angiomatosis (BA) is a rare infectious disease, caused by bacteria of the genus Bartonella spp, transmitted by vectors such as fleas, lice and mosquitoes. It causes different clinical syndromes in humans. In patients with human immunodeficiency virus (HIV) infection with an LT CD4 + <100 cell/µL count, it is associated with the development of angiomatous lesions with neovascularization involving the skin and, with less frequency, mucous membranes, liver, spleen and bones. Kaposi's sarcoma (KS) is a neoplasm characterized by multifocal vascular hyperplasia of endothelial origin related to human herpes virus 8. It can also compromiso the skin, mucous membranes and viscera, with the epidemic variant being a marker disease of advanced HIV infection. The main clinical differential diagnosis for KS skin and mucosal lesions is the BA.Herein we present a patient with HIV/AIDS disease that developed BA and KS concomitantly in the same skin lesion

Sarcoma de Kaposi en conjuntiva bulbar / Kaposi´s sarcoma in bulbar conjunctiva

Paciente masculino de 29 años de edad, raza blanca, soltero, profesor universitario, con antecedentes de padecer crisis de epilepsia tratado con fenitoína y actualmente controlado, menciona que desde hace aproximadamente 4 semanas comenzó con ojo rojo y molestias oculares del ojo derecho, por lo cual acudió a su área de salud donde fue tratado como cuadro de conjuntivitis. No mostró mejoría alguna, sino empeoramiento del cuadro clínico, y observó un enrojecimiento ocular intenso en el ángulo interno de dicho ojo que se fue extendiendo, acompañado de ligera fotofobia. Por la tórpida evolución del cuadro decidió acudir a nuestra institución por lo cual fue remitido a la Consulta de Oculoplastia. También refirió que desde hacía dos meses había presentado anorexia, dificultad al comer, así como pérdida de peso, por lo cual se decidió comenzar estudio y tratamiento. Se decidió realizar la resección de la masa tumoral en conjuntiva bulbar y se envió para estudio anatomopatológico. El resultado fue compatible con un sarcoma de Kaposi(AU)

A twenty-nine years-old male Caucasian patient, single and university professor, with a history of epilepsy treated with fenitoin and managed at present. He stated that 4 weeks ago approximately, he began feeling ocular discomfort in addition to reddened eye, so he went to his health area where he was treated as a conjunctivitis case. No improvement occurred, the clinical picture worsened and there was intensive ocular reddening in the internal angle of the eye that extended and mild photofobia. Because of the rapid profession of the clinical picture, he decided to go to our institution where he was referred to the Oculoplasty Service. He also said that he had been suffering anorexia, difficulties to eating and weight loss two months ago. It was then decided to start the study and treatment of this case. First, the tumor mass from the bulbar conjunctiva was resected and then sent to anatomical pathological study service. The result was compatible with Kaposi´s sarcoma diagnosis(AU)

Consensus of the Brazilian Society of Infectious Diseases and Brazilian Society of Clinical Oncology on the management and treatment of Kaposi's sarcoma

Kaposi's sarcoma is a multifocal vascular lesion of low-grade potential that is most often present in mucocutaneous sites and usually also affects lymph nodes and visceral organs. The condition may manifest through purplish lesions, flat or raised with an irregular shape, gastrointestinal bleeding due to lesions located in the digestive system, and dyspnea and hemoptysis associated with pulmonary lesions. In the early 1980s, the appearance of several cases of Kaposi's sarcoma in homosexual men was the first alarm about a newly identified epidemic, acquired immunodeficiency syndrome. In 1994, it was finally demonstrated that the presence of a herpes virus associated with Kaposi's sarcoma called HHV-8 or Kaposi's sarcoma herpes virus and its genetic sequence was rapidly deciphered. The prevalence of this virus is very high (about 50%) in some African populations, but stands between 2% and 8% for the entire world population. Kaposi's sarcoma only develops when the immune system is depressed, as in acquired immunodeficiency syndrome, which appears to be associated with a specific variant of the Kaposi's sarcoma herpes virus. There are no treatment guidelines for Kaposi's sarcoma established in Brazil, and thus the Brazilian Society of Clinical Oncology and the Brazilian Society of Infectious Diseases developed the treatment consensus presented here.

Sarcoma de Kaposi en mucosas en pacientes PPVI: a propósito de 2 casos: revisión de bibliografía / Kaposi´s Sarkoma (KS) in patiens living with HIV: apropos of 2 cases: review of literature

El Sarcoma de Kaposi (SK) es un tumor vascular que puede comprometer la piel. En 1872 el dermatólogo vienés Moritz Kaposi describió por primera esta entidad. Tradicionalmente se la ha considerado un proceso crónico, decurso lento, que afecta sobre todo a hombres ancianos del este de Europa. No recibió mayor atención hasta que apareció como epidemia en hombres que tienen sexo con hombres (HSH) en la década de los 80 y fue reconocido como marcador clínico de SIDA. Describimos nuestra experiencia en la Unidad de Atención y Control en Salud Sexual (UNACESS) de dos varones PPVI: uno con lesión en cara mucosa del prepucio y otro con lesiones palatinas.

Kaposi’s Sarcoma (KS) is a vascular tumor that can involve the skin. In 1872 the Viennese dermatologist Moritz Kaposi first described this entity. Traditionally it has been considered a chronic, slow flowing, mainly affecting elderly men of Eastern Europe. KS received no more attention until it appeared as an epidemic among men who have sex with men (MSM) in the 80s and was recognized as a clinical marker of AIDS. We describe our experience in Care and Control Unit Sexual Health (UNACESS) in two men living with VIH infection, one with penile mucosa injury and another with palatal lesions.

Classic Kaposi's sarcoma treated with elastic stockings and outpatient follow-up of a 90-year-old patient / Sarcoma de Kaposi classico tratado com meias elasticas e acompanhamento ambulatorial numa paciente de 90 anos

Kaposi's sarcoma is a multifactorial angioproliferative disorder. The herpes virus 8 human contributes to its pathogenesis, but it is uncertain whether these lesions are only reactive hyperplasia to the virus or neoplasia. Four clinical types are described: classic, endemic, iatrogenic and HIV-associated. Classic Kaposi's sarcoma has no standard staging or treatment protocols. Some studies have shown the use of compression stockings in the treatment of lymphedema associated with Kaposi's sarcoma. We report the case of a 90 year-old patient with classic Kaposi's sarcoma treated with compression stockings who showed a satisfactory response.

O sarcoma de Kaposi é uma desordem angioproliferativa de causa multifatorial. O vírus herpes 8 participa na sua patogenia, porém há dúvidas se a origem das lesões é apenas por hiperplasia reacional ao vírus ou uma neoplasia propriamente dita. Quatro tipos clínicos são descritos: clássico, endêmico, iatrogênico e associado ao HIV. O tipo clássico de sarcoma de Kaposi mantém-se sem padronização de estadiamento ou protocolos de tratamento. Há alguns estudos mostrando o uso de meias compressivas no tratamento do linfedema associado ao Kaposi Comunicamos um caso de uma paciente de 90 anos com sarcoma de Kaposi clássico tratado com meias elásticas compressivas, mostrando uma resposta satisfatória.

[Kaposi's disease: epidemiological, clinical, anatomopathological and therapeutic features in 75 patients]

Kaposi's sarcoma [KS] is a mutifocal angiogenic process characterized by cellular and vascular proliferation. To identify the epidemio-clinical, histological and therapeutic features of KS. Retrospective study of 75 cases of KS at the dermatology department of Rabta hospital in Tunis during a period of 25 years [1982-2007]. Three epidemio-clinical forms of KS were observed in our study: the classic KS [70 cases], the AIDS-related KS [4 cases] and the iatrogenic KS [1 case]. The mean age of our patients at diagnosis was 69.16 years with a sex ratio of 2.33. Elective site of cutaneous lesions in the classic KS was the limbs [87.1%]. The cephalic part was concerned in 17.1% of cases. Mucosal involvement was found in 28.5% of patients. Extra dermatological localizations of KS were observed in 32.9%. Our study identified some epidemio-clinical features of the classic KS especially the high frequency of mucosal and cephalic involvement as well as extra dermatological localizations. Thus further exploration is required even without alarm signs

Sarcoma de Kaposi asociado a VIH: uso de doxorrubina liposomal terapia antirretroviral de alta eficacia / Kaposi syndrome associated to HIV use of liposomal doxorrubicin high efficacy entirretroviral therapy

No existen criterios definidos para el tratamiento del sarcoma de Kaposi asociado a infección por VIH en la era de terapia antirretroviral de alta eficacia. Hay evidencias de regresión de lesiones cutáneas solamente con terapia antirretroviral sin quimioterapia; es muy poco probable que lesiones viscerales y mucosas respondan sin administración simultánea de quimioterapia. Estudio prospectivo en pacientes Kaposi de “bajo riesgo” y “alto riesgo”, tratando de definir el momento oportuno de quimioterapia simultáneamente con administración de terapia antirretroviral. 66 pacientes 28 (42 por ciento) T0I0S0, 6 (9 por ciento) T0I0S1, 8 (12 por ciento) T0I1S1, 5 (8 por ciento) T1I1S0 y 19 (29 por ciento) T1I1S1. Todos los pacientes T1, T0I1S1 y un tercio de T0I0S1 fueron tratados con quimioterapia (4 a 8 ciclos con doxorrubicina liposomal) ninguno de los pacientes T0I0S0 recibió quimioterapia. Total de 34 respuestas clínicas, 6 (18 por ciento) completas (3 T1I1S1, 2 T1I1S0, y 1 T0I0S1), 23 (68 por ciento) parciales (16 T1I1S1, 3 T1I1S0, 3 T0I1S1 y 1 T0I0S1) y 5 (14 por ciento) estabilizaron enfermedad (T0I1S1). Pacientes con tumor extenso (T1) requieren quimioterapia desde el diagnóstico, y administración de antirretrovirales. Pacientes con tumores localizados, con nivel células CD4 ≤200/μL (II), síntomas sistémicos requieren quimioterapia aproximadamente 2 a 3 meses después del inicio terapia antirretrovitral, ninguno de los pacientes con tumores localizados, sin síntomas sistémicos, y nivel células CD4 > 200/μL (I0) van a requerir quimioterapia, al menos durante un promedio de 20 meses.

At present there are no defined criteria for treating Kaposi´s sarcoma associated with HIV in the era of highly active antiretroviral therapy. Evidence of regression of cutaneous lesions with only retroviral high efficacy therapy without need of chemotherapy; nevertheless, it is very unlikely that visceral or mucous lesions respond to retroviral without simultaneous initiation chemotherapy. Prospective study in “low risk” and “high risk” Kaposi patients, trying to define the adequate moment for initiating the chemotherapy simultaneously with retroviral. 66 male Kaposi patients, 28(42 percent) T0I0S0, 6 (9 percent) T0I0S1, 8 (12 percent) T0I1S1, 5 (8 percent) T1I1S0 y 19 (29 percent) T1I1S1. All T1, T0I1S1 and a third of T0I0S1 patients were treated with chemotherapy (4 to 8 cycles with liposomal doxorubicin) but none of the T0I0S0 patients. 34 clinical responses, 6 (18) complete (3 T1I1S1, 2 T1I1S0, and 1 T0I1S1), 23 (68 percent) partial (16 T1I1S1, 3 T1I1S0, 3 T0I1S1, and 1 T0I0S1) and 5 (14 percent) stable disease (T0I1S1). All patients with extensive tumors require chemotherapy administration since the moment of diagnosis, together with retroviral high efficacy agents. Patients with localized tumors, CD4 cell levels ≤ 200/μL), and systemic symptoms will require chemotherapy in approximately 2 to 3 months period after initiation of retroviral, while none of patients with localized tumors, without systemic symptoms, and CD4 cell levels > 200/μL will require chemotherapy, at least in a mean 20 months follow-up period.

Inmunosupresores y cáncer de piel / Inmunosuppressive drugs and skin cancer

El trasplante de órganos, uno de los avances más sorprendentes de la medicina junto con el desarrollo de agentes inmunosupresores cada vez más eficaces, modificó el curso de enfermedades terminales devastadoras. Sin embargo, esta práctica médica nos enfrenta a una población cada vez más longeva que padece las complicaciones secundarias de la inmunosupresión crónica, necesaria para asegurar la supervivencia del injerto. La elevada incidencia de neoplasias interna y, en particular, cutáneas plantea la necesidad de un manejo interdisciplinario. En este sentido, el médico dermatólogo desempeña un papel protagónico en la prevención, el diagnóstico y el tratamiento de estos procesos malignos.

Sarcoma de Kaposi asociado al SIDA / Management of aids-related Kaposi's sarcoma

Kaposi's sarcoma is a multicentric neoplasm highly vascularized, and represents the most frequent malignancy among HIV-infected pesons, abeing its estimated incidence 900 thousand times higher among HIV-infected persons than in those who are not...The high incidence of disease in homosexual and bisexual men has implicated environmental and infectious factors. The authors of this reort, describe the epidemiology and pathogenesis, diagnostic evaluation and extension of the disease, and with special consideration on treatment

Sarcoma de Kaposi peniano em paciente HIV negativo: relato de caso / Kaposi's sarcoma in a HIV negative patient. Case report

Os autores reportam uma lesão incomum em pacientes HIV negativos. O quadro clínico apresentou-se através do surgimento de lesão violácea, nodular, única, em glande peniana. A lesão foi submetida á biópsia excisional e o resultado histopatológico foi de Sarcoma de Kaposi (SK). A pesquisa do herpes vírus humano tipo 8 (HVV8) através do PCR (polymerase chain reaction) foi positiva no fragmento de biópsia. Não havia nestse caso o acometimento de outros sítios, sendo a ressecção de caráter curativo.

Prevalence of koposi's sarcoma in north of Iraq after the second gulf war 1991

Is to show the marked increase in the incidence of Kaposi's sarcoma specially atypical fulminating forms in the north provinces of Iraq after the Second Gulf War 1991. A retrospective comparative study of 404 patients with the diagnosis of Kaposi's sarcoma [372 men and 32 women], their ages ranged between 54 and 75 years, admitted to the surgical and dermatological departments in north provinces from June 1994 till September 2004. The clinical presentation of the patients, hematological and serological investigations, imaging and radiological studies were considered in all the cases. Final diagnosis was established by hitopathological examinations. Patients with the diagnosis of Kaposi's sarcoma were divided into 3 main groups according to the clinical and pathological behavior of the disease: Group I, [276 patients, 68.3%] with typical classical type of Kaposi's sarcoma, and group II [116 patients, 28.7%] with atypical fulminating types [lymph-adenopathic; African], and group III [12patients, 1.9%] with immunosuppresion associated [transplant] form of disease were studied. The diagnosis was confirmed by histological examinations of the skin, oral lesions, bronchial and visceral lesions. 44 patients underwent explorative laparotomies and diagnostic laparoscopy because of the dominancy of the abdominal symptoms and signs, 40 of them required more than one surgical intervention because of widespread of the tumor. Local statistical data collected from the tumor registration centers in north of Iraq revealed that the incidence of KS in North of Iraq [Mousl, Erbil, and Dohuk] between years 1980-1990 was 0.6 per 100000 populations, while the incidence became 3.6 per 100000 populations between years 1991-2004 [6 folds increase] after the Second Gulf War 1991. Chest and visceral involvement by KS was extremely rare before nineties, but in the last 10 years the incidence of visceral presentations with a typical fulminating forms of Kaposi's sarcoma was frequent

Kapsoi sarcoma after kidney transplantation: a study of 10 cases from a series of 580 kidney transplantations in a University Hospital in Damascus, Syria

To identify the common causes of injuries among children in this region and suggest preventative strategies. This is a hospital based retrospective review of the files of children under the age of 14 years who presented to the general emergency department at Al-Thawra General Hospital with acute injury and were admitted to the hospital between January 1, 2003 and December 31, 2004. All charts were reviewed for age, sex, place and mechanism of injury, body area injured, and length of stay in the hospital. The total number of children was 421. The mean age was 6.5 years [range 0-14], 62.2% [n=262] were boys and 37.8% [n=159] were girls. The most common trauma type was head injury n=125 [29.7%]. The head injury was of two types; inflicted [intentional] n=112, [89.6%] and traffic accidents [accidental] n=13 [10.4%]. Among the inflicted type, contusion [33.03% in males, 11.60% in females] was the most common mechanism of injury, followed by falls from heights [FFH] 8.92% in males, 5.35% in females, then sharp objects [8.03% in males, 3.57% in females]. Roads were the most common place of trauma in the study, n=256 [60.80%]. In this category, 74[59.2%] of 125 head injuries occurred in roadways. In the age group between 5-10 years, n=182 [43.2%], the commonest cause of trauma was traffic accidents [69.23%]; however, only 13 [10.4%] caused head injuries. The head was the most common body area injured and the main cause of hospital admission [29.69%]. The mortality rate among the children was 35.15% [67.56% male, 32.43% female]. Traffic accidents [RTA], falls, and home injuries are the commonest causes of morbidity and mortality for children in our community. The highest proportions of deaths and severe injuries were observed in the school age group. Prevention strategies must consider this high-risk age group

Sarkoma de Kaposi clássico / Classic Kaposi's sarcoma

Os autores relatam um caso clínico de sarcoma de Kaposi clássico (SKC) em paciente idoso, masculino, não-HIV-positivo, portador de laudo histopatológico incorreto, o que dificultou o diagnóstico. A conclusão final foi obtida por forte suspeita clínica e solicitação de nova biópsia da lesão com análise imuno-histoquímica.

[Tumoral cutaneous form of kaposi's sarcoma: Diagnosis difficulties case report]

Kaposi's sarcoma is the most frequent neoplasia related to AIDS. We report here the difficulties of diagnosis and therapeutic of an atypical cutaneous form of Kaposi's sarcoma. A 31-year-old woman HIV- infected with severe immunodeficiency [CD4 cell count is 50 cell/mm[3] and HIV RNA viral load is 539000 copies /ml] was admitted for an atypical cutaneous kaposi's sarcoma. She was first treated by antiretroviral therapy combined stavudine, lamivudine and indinavir added to bleomycm monochimiotherapy. One month after, she developed persistent cough and new lesions of Kaposi sarcoma which a big pseudotumoral frontal one. Bronchoscopy showed pulmonary Kaposi's sarcoma. Polychimiotherapy [bleomycin, donorubicin et vinblastin], and local treatment were instituted with regression of lesions. Combined antiretroviral therapy, by increasing immune restoration, leaded to recovery

diagnostic challenge and management of pulmonary Kaposi's sarcoma in renal transplant recipients

Kaposi's sarcoma is a multicentric low grade tumor that usually begins with the development of violaceous skin lesions and is associated with the presence of human herpes virus 8. Kaposi's sarcoma has been described in immunocompromised patients, particularly following renal transplantation, with cutaneous involvement being the most salient finding. Infectious and non-infectious pulmonary disorders in immunocompromised patients can simulate the radiological manifestations of pulmonary Kaposi's sarcoma. This report highlights the dilemma in reaching an accurate diagnosis of pulmonary Kaposis sarcoma as a complication of immunosuppression post-renal transplant and reviews the management of immunosuppression related Kaposi's sarcoma

Kaposi's sarcoma occurring during short-term dialysis: report of two cases

Kaposi's sarcoma (KS) appears to develop in association with kidney transplantation, but unlikely with dialysis. We report two cases of classic KS that occurred in patients receiving short-term (less than 3 yr) dialysis. They have been suffering from chronic renal failure due to tuberculosis and diabetes mellitus, respectively. Several to multiple, reddened-violaceous patches, plaques and nodules were found on the hand and the lower extremities. Laboratory studies showed no evidence suggesting immunosuppressed state and there was no history of taking immunosuppressive agents. The biopsies of the two cases revealed proliferation of spindle-shaped cells focally arranged in bundles and multiple dilated vascular spaces outlined by an attenuated endothelium with intravascular and extravasated erythrocytes. The specimens expressed positivity with CD34 antigen. Human herpesvirus 8 (Kaposi's sarcoma-associated herpesvirus) was detected in one case by polymerase chain reaction method.

Lesiones orales en pacientes inmunodeprimidos / Oral lesions in immunodepressed patients

Los estados de inmunodepresión han aumentado su prevalencia en los últimos años. A los esporádicos casos de inmunodepresiones primarias se le suman cada vez más los provenientes de tratamientos por tumores malignos, enfermedades autoinmunes, trasplantes y fundamentalmente, la infección por HIV-1 que se transformó, sin dudas, en la principal causa. Se describen las lesiones orales siguiendo la clasificación internacional vigente. Se presenta la prevalencia de las mismas sobre 3056 pacientes HIV-1+ registrados en la Sala 17 del Hospital de Infecciosas "Francisco J. Muñiz" de la Ciudad de Buenos Aires. Se hacen consideraciones sobre la clasificación y se establece la importancia de las lesiones orales en el SIDA, concluyendo que son: indicadoras de infección por HIV-1, predictoras de progresión de la inmunodepresión subyacente, se utilizan para sistemas de clasificación y control de terapias, algunas son lesiones de exclusiva ubicación en la cavidad bucal, otras son expresiones orales de enfermedades generales que pueden tener en la boca sus primeras manifestaciones o los signos más claros para su diagnóstico, producen alteraciones funcionales (fonación, masticación, deglución, gusto), dolor y halitosis. Se han logrado adelantos en el manejo terapéutico de las mismas a expensas de la gran casuística y una mayor investigación abocada al tema.

Sarcoma de kaposi clásico: presentación de un caso y revisión / Classic kaposi sarcoma: case presentation and review

Presentación del caso de un paciente masculino de ochenta y cuatro (84) años de edad cardiópata, manejado con diuréticos, digoxina y aspirina, con historia de diez (10) meses de iniciar lesiones nodulares en planta de pie izquierdo de crecimiento lento, en forma ascendente hasta muslo, asintomáticas de coloración eritemato-violaceas. Se toma biopsia de piel con consideraciones diagnósticas: cancer metastásico, melanoma, angiomatosis bacilar, sarcoma de kaposi (sk). Se confirma este último con examen HIV negativo, por lo que por su forma de presentación clínica, edad del paciente y serología negativa, se llega a la conclusión que se trata de un S.K. clásico

Tratamento sistêmico do sarcoma de Kaposi associado a AIDS: estudo clínico e farmacológico com doses fracionadas de etoposida por via oral / Treatment of AIDS related Kaposiïs sarcoma: clinical and pharmacological study with oral etoposide

Os objetivos deste estudo foram: avaliar a atividade antitumoral, a toxicidade e a farmacocinética da etoposida em doses orais fracionadas por um período de tempo prolongado em pacientes com Sarcoma de Kaposi avançado associado a AIDS; determinar o percentual de respostas objetivas alcançado pela etoposida na posologia proposta no estudo; estabelecer o perfil e a gravidade dos efeitos tóxicos apresentados pelos pacientes nesse esquema de administração da etoposida e descrever a farmacocinética da etoposida no plasma dos pacientes incluidos no estudo