Oral Kaposi sarcoma following cord blood transplantation.

Abstract

A 50-year-old man developed acute myeloid leukemia while receiving antiretroviral therapy for human immunodeficiency virus (HIV) infection. Following three courses of chemotherapy, he received cord blood transplantation (CBT) in the first complete remission. The patient developed mild skin acute graft-versus-host disease after CBT. In addition, he developed organizing pneumonia 1 month after CBT, which responded to steroid therapy, but repeatedly relapsed during steroid tapering. Thus, he had been receiving prolonged immunosuppressive therapy. Thirteen months after CBT, bluish-red elevated lesions developed on the hard palate of the oral cavity (Figure 1A). Biopsy samples obtained from the palate lesions confirmed the diagnosis of Kaposi sarcoma (KS). His HIV viral load was undetectable, and there were no signs of leukemia relapse. To improve the immunosuppression status, immunosuppressive therapy was attenuated. This led to the increase in CD4+ count from 0.26 × 109/L to 0.68 × 109/L and regression of the KS (Figure 1B, 18 months after CBT). However, the patient succumbed to heart and kidney failure 18 months after CBT. Despite its rarity, KS should be considered as a differential diagnosis when hematopoietic stem cell transplantation recipients develop bluish-red or purple lesions. The authors declare no conflict of interest. N.I., M.A., A.I., M.M, H.N., and H.I. were involved in the management of the patient. N.I., H.N., and H.I. wrote the manuscript. N.I., M.A., and A.I. prepared the figure. All authors reviewed and approved the manuscript. Informed consent was obtained from the patient.