Abstract
Pulmonary Kaposi sarcoma (KS) is a low-grade malignant neoplasm associated with human herpesvirus-8 (HHV-8), seen predominantly in immunocompromised hosts. Classically, diagnosis relies on the combination of clinical history, exclusion of alternative infectious and neoplastic etiologies, and histopathologic confirmation of proliferating spindle cells staining positive for HHV-8. Tissue-based diagnosis requires bronchoscopy with biopsy and is associated with procedural complications, such as bleeding and pneumothorax.
Highlights
Pulmonary Kaposi sarcoma (KS) is a low-grade malignant neoplasm associated with human herpesvirus-8 (HHV-8), seen predominantly in immunocompromised hosts
Diagnosis relies on the combination of clinical history, exclusion of alternative infectious and neoplastic etiologies, and histopathologic confirmation of proliferating spindle cells staining positive for HHV-8
We describe a patient with a delayed diagnosis of pulmonary KS by classical invasive modalities, highlight rapid and non-invasive diagnostic testing through retrospective application of metagenomic sequencing, and illustrate the complex clinical course which led to the patient’s demise
Summary
Pulmonary Kaposi sarcoma (KS) is a low-grade malignant neoplasm associated with human herpesvirus-8 (HHV-8), seen predominantly in immunocompromised hosts. Tissue-based diagnosis requires bronchoscopy with biopsy and is associated with procedural complications, such as bleeding and pneumothorax In this case report, we describe a patient with a delayed diagnosis of pulmonary KS by classical invasive modalities, highlight rapid and non-invasive diagnostic testing through retrospective application of metagenomic sequencing, and illustrate the complex clinical course which led to the patient’s demise. A 40-year-old African-American male with human immunodeficiency virus (HIV) with CD4 count 11 cells/ mL and an undetectable viral load on antiretroviral therapy and recent Cryptococcus neoformans meningitis on suppressive fluconazole therapy was admitted to the intensive care unit (ICU) with two weeks of progressive exertional dyspnea He was found to have acute hypoxemic respiratory failure requiring mechanical ventilation. The patient underwent fluoroscopic-guided iliac crest bone biopsy on hospital day ten for incidentally discovered lytic lesions on imaging, which revealed spindle cell
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