Http://www.omicsonline.org/open-access/doc-i-just-cant-swallow-pills-hiv-infected-patients-and-pill-phagophobia-2155-6113.1000348.php?aid=32174

Abstract

Introduction: Kaposi Sarcoma (KS) is a soft tissue malignancy that has been categorized into 4 subtypes, however, in the United States, it has frequently been noted in patients with HIV/AIDS and has thus become known as an AIDS-defining illness. When KS is found in the oral cavity, it is usually seen on the hard palate. Oral KS (OKS) is most commonly seen in patients with HIV/AIDS with CD4 counts below 200, and the disease is rarely reported outside of this patient population. HIV patients may be more likely to have KS with the decline of their immune function. Report of case: We report the case of a 31 year old African American male with a 2 year history of HIV who presented to the Otolaryngology clinic with a painful tongue lesion. His CD4 count never fell below 200, which makes this case an outlier among the epidemiology of KS. This case is unique in two different ways. The dorsum of the tongue is one of the least common manifestations of OKS and secondly OKS is usually associated with CD4 counts <200 per microliter, and this patient’s CD4 count stayed above 200 cells per microliter throughout his evaluation and treatment. The tongue lesion was causing dysphagia and odynophagia that was significant enough to cause him to seek medical care. Discussion: Despite the relatively adequate resources for HAART therapy among the American indigent population, some patients still decline this highly efficacious treatment and succumb to its now rare complications. Physicians must actively investigate suspicious oral lesions in HIV patients, particularly when there is a question about the compliance of HAART therapy or other concerning features. The oral cavity may be the initial manifestation site for HIV associated KS thus any suspicious lesion in sexually active patients should lead to testing for HIV.