PULMONARY KAPOSI SARCOMA WITH ASSOCIATED RECURRENT CHYLOTHORAX

Abstract

SESSION TITLE: Pneumothorax, Chylothorax, and Pleural Effusion Case PostersSESSION TYPE: Case Report PostersPRESENTED ON: 10/17/2022 12:15 pm - 01:15 pmINTRODUCTION: AIDS related Kaposi Sarcoma (KS) is an endothelial malignancy associated with HHV8 infection. It is the most common malignancy in patients with AIDS. Pulmonary KS is uncommon and rarely causes pleural effusions, particularly chylothorax. Here we present a case of recurrent chylothorax leading to diagnosis of pulmonary KS by pleural biopsy.CASE PRESENTATION: 40-year-old male with HIV/AIDS on HAART therapy and KS was referred for pleural effusion. He was previously treated with Doxil for gastrointestinal KS, but stopped due to neutropenia. He had persistent shortness of breath and occasional night sweats. A thoracentesis was performed, and fluid studies were consistent with a chylothorax. He had a recurrent pleural effusion two months later, and he underwent right sided pleuroscopy with pleural biopsies, talc pleurodesis, and tunneled pleural catheter placement. Diffuse hemorrhagic lesions throughout the right lung, and a raised plaque like lesion along the parietal pleura were seen during pleuroscopy. Biopsy of the parietal pleural was consistent with metastatic KS. He will discuss treatment with his oncologist.DISCUSSION: Pulmonary KS is uncommon and rarely causes pleural effusions, particularly chylothorax. Thoracoscopy is usually not needed to diagnose pulmonary KS as it should only affect visceral pleura. As in this case, thoracoscopy is typically used to assist with patient's symptoms and rule out other causes of an effusion. This is a rare case of KS causing chylothorax requiring thoracoscopy and biopsies for diagnosis.CONCLUSIONS: Here we present a case of pulmonary KS with accompanying chylothorax. This is not a typical presentation or path to diagnosis for pulmonary KS.Reference #1: Cherian S, Umerah OM, Tufail M, et al. Chylothorax in a patient with HIV-related Kaposi's sarcoma. BMJ Case Reports CP2019;12:e227641.Reference #2: Ramos A, Granado J, et al. Pulmonary Kaposi Sarcoma - An atypical clinical presentation. International Journal of Infectious Disease. 2022;115:185-188.Reference #3: Pandya K, Lal C, et al. Bilateral Chylothorax with Pulmonary Kaposi's Sarcoma. Chest. 1988;94(6):1316-1317.DISCLOSURES: No relevant relationships by Harshesh AminNo relevant relationships by Yanglin GuoNo relevant relationships by John HeneganNo relevant relationships by Rachel MullinsNo relevant relationships by Randolph Ross SESSION TITLE: Pneumothorax, Chylothorax, and Pleural Effusion Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: AIDS related Kaposi Sarcoma (KS) is an endothelial malignancy associated with HHV8 infection. It is the most common malignancy in patients with AIDS. Pulmonary KS is uncommon and rarely causes pleural effusions, particularly chylothorax. Here we present a case of recurrent chylothorax leading to diagnosis of pulmonary KS by pleural biopsy. CASE PRESENTATION: 40-year-old male with HIV/AIDS on HAART therapy and KS was referred for pleural effusion. He was previously treated with Doxil for gastrointestinal KS, but stopped due to neutropenia. He had persistent shortness of breath and occasional night sweats. A thoracentesis was performed, and fluid studies were consistent with a chylothorax. He had a recurrent pleural effusion two months later, and he underwent right sided pleuroscopy with pleural biopsies, talc pleurodesis, and tunneled pleural catheter placement. Diffuse hemorrhagic lesions throughout the right lung, and a raised plaque like lesion along the parietal pleura were seen during pleuroscopy. Biopsy of the parietal pleural was consistent with metastatic KS. He will discuss treatment with his oncologist. DISCUSSION: Pulmonary KS is uncommon and rarely causes pleural effusions, particularly chylothorax. Thoracoscopy is usually not needed to diagnose pulmonary KS as it should only affect visceral pleura. As in this case, thoracoscopy is typically used to assist with patient's symptoms and rule out other causes of an effusion. This is a rare case of KS causing chylothorax requiring thoracoscopy and biopsies for diagnosis. CONCLUSIONS: Here we present a case of pulmonary KS with accompanying chylothorax. This is not a typical presentation or path to diagnosis for pulmonary KS. Reference #1: Cherian S, Umerah OM, Tufail M, et al. Chylothorax in a patient with HIV-related Kaposi's sarcoma. BMJ Case Reports CP2019;12:e227641. Reference #2: Ramos A, Granado J, et al. Pulmonary Kaposi Sarcoma - An atypical clinical presentation. International Journal of Infectious Disease. 2022;115:185-188. Reference #3: Pandya K, Lal C, et al. Bilateral Chylothorax with Pulmonary Kaposi's Sarcoma. Chest. 1988;94(6):1316-1317. DISCLOSURES: No relevant relationships by Harshesh Amin No relevant relationships by Yanglin Guo No relevant relationships by John Henegan No relevant relationships by Rachel Mullins No relevant relationships by Randolph Ross