Abstract
During HIV infection, hematological manifestations are frequently associated with various pathogenic mechanisms, which require a multidisciplinary approach. We present the case of a 57-year-old patient with pancytopenia associated with Kaposi's sarcoma, as indicative manifestations of the acquired immunodeficiency syndrome. The late diagnosis of HIV infection, in the stage of severe immunosuppression, the association of opportunistic neoplasia, delayed oncological therapy and the development of immune reconstruction syndrome after starting antiretroviral therapy have contributed to the severe evolution and death of the patient.
Highlights
Pancytopenia is a syndrome often found in hematological clinical practice, defined by the concomitant decrease of the three hematopoietic lines, characterized by hemoglobin values < 10 g/dl, leukocytes < 4,000/mmc and platelets < 150,000/mmc [1].Pancytopenia is not a disease by itself, but can suggest the first sign of several pathologies, with various etiologies, which are classified into the following groups: decreased bone marrow function, inefficient erythropoiesis or increased peripheral destruction [2]
Human immunodeficiency virus (HIV) infection is often associated with pancytopenia, which can occur through multiple mechanisms, especially induced by the direct cytopathic effect of HIV, opportunistic infections, immune mechanisms, neoplasms, drug toxicity [3]
The macroscopic appearance of the skin lesions was suggestive of Kaposi’s sarcoma, that is frequently related to severe immunosuppression human immunodeficiency virus (HIV)
Summary
Pancytopenia is a syndrome often found in hematological clinical practice, defined by the concomitant decrease of the three hematopoietic lines, characterized by hemoglobin values < 10 g/dl, leukocytes < 4,000/mmc and platelets < 150,000/mmc [1]. Frequency and severity of HIV-associated hematological manifestations are higher in advanced stages of immunosuppression (AIDS), characterized by high viral replication and low levels of T-CD4 lymphocytes. The macroscopic appearance of the skin lesions was suggestive of Kaposi’s sarcoma, that is frequently related to severe immunosuppression human immunodeficiency virus (HIV). The general condition was worsening, with fever, extensive skin and oral mucosal lesions, difficulty in swallowing and breathing This paradoxical evolution fits within the definition of inflammatory immune reconstruction syndrome (IRIS), with clinical outcome improved after corticosteroid therapy, in the 2 weeks. Febrile episodes reappeared, with predominantly nocturnal sweating, weight loss and progressive clinical decline, dying after 16th weeks from HIV diagnosis
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