DIAGNOSING KAPOSI'S SARCOMA IN ABSENCE OF CUTANEOUS LESIONS IN THE HAART ERA

ABSTRACT

TYPE Case Report TOPIC Chest Infections INTRODUCTION: Kaposi sarcoma (KS) is very commonly associated with Human Immunodeficiency Virus (HIV) infection. The clinical course of HIV associated KS could be indolent with muco-cutaneous or aggressive with visceral organ system involvement. It is extremely uncommon for the visceral involvement to occur in the absence of mucocutaneous manifestations. CASE PRESENTATION A 45-year male with HIV, presented with fatigue, exertional dyspnea, cough. Vital signs showed low grade fever and hypoxia. On physical exam the pertinent positive finding was diffuse inspiratory crackles. The CT chest showed multiple irregular nodular infiltrates in the lungs. Blood and sputum cultures were collected, and the patient was started on empiric antibiotics and fluconazole. The viral load and the absolute CD4 count were 64,360 and 17, respectively. The transesophageal echocardiogram was negative for vegetations. SARS-COVID19, blood culture and three sputum acid fast bacilli were negative. The patient continued to worsen. The bronchoscopy showed a friable mass in the left lower trachea. The immunohistochemistry analysis of the lesions was positive for CD34, CD31, HHV-8, FLI-1 which was diagnostic of KS. The patient was started on Highly Active Antiretroviral Therapy (HAART) and was discharged on HAART with a scheduled follow up. DISCUSSION: The introduction of HAART has decreased the incidence of KS to 0.03 per 1000 patient years in the HAART era. 15.5 % of patients have pulmonary KS in the absence of mucocutaneous lesions. These rates of pulmonary KS in autopsy findings were noted in the pre-HAART era. CONCLUSIONS: To establish a diagnosis of pulmonary KS in the absence of the characteristic cutaneous lesions is challenging. DISCLOSURE Nothing to declare. KEYWORD Kaposi Sarcoma