Case Of Kaposi Research Articles

Randomized, controlled phase II trial of subcutaneous interleukin-2 in combination with highly active antiretroviral therapy (HAART) in HIV patients

To determine the immunological, virological and clinical effects of subcutaneous IL-2 in 44 HIV-patients in conjunction with pre-existing tri-therapy (zidovudine, 3TC, saquinavir). Partially randomized, controlled, prospective trial. Single center study at tertiary care center. Sixty four patients (CD4 count 200-500 x 10(6)/l). Fourty four patients were randomized to receive 5-day cycles of IL-2 (9 Mio IU/d) every 6 weeks (Group A) or whenever the CD4 cell count dropped below the 1.25-fold of baseline (Group B), whereas 20 control patients received the same HAART without IL-2. The optimal individual treatment interval and the immunological and virological effects of subcutaneously administered IL-2 were analysed. Importantly, the level of cellular in vivo immunity and the frequency of dermatological marker diseases and infectious complications were assessed. IL-2 was well tolerated although fever, influenza-like symptoms and indurated injection sites were commonly encountered. After 1 year of IL-2, there was a median increase of more than 100 x 10(6)/l CD4 cells in both IL-2 groups in contrast to the controls (P < 0.01, 0.01 and not significant). The median HIV load did not increase either in plasma or in lymph nodes. Lymphocyte activation decreased as assessed by MHC class II (P < 0.001), CD25 (P < 0.001) and CD38 expression (P < 0.005). Although delayed type hypersensitivity against common recall antigens increased in both IL-2 groups, it did not reach statistical significance. However, it is of note, that in 7 of 11 (63.6%) patients delayed type hypersensitivity against recombinant HIV antigens improved significantly. Whereas there was no opportunistic infection in either IL-2 group, three cases of Kaposi's sarcoma occurred in the controls. Dermatological indicator diseases (thrush, condyloma, herpes simplex) were found to occur more frequently in the control group. Subcutaneous IL-2 in addition to HAART was safe and led to sustained qualitative and quantitative immunological improvements in the majority of patients. Individualisation of therapy intervals further improved the efficacy and tolerance of IL-2.

Further confirmation of the association of human herpesvirus 8 with Kaposi's sarcoma.

Recently, a new herpesvirus-like DNA sequence named Kaposi's sarcoma-associated herpesvirus (KSHV) or human herpesvirus 8 (HHV8) has been isolated from almost all cases of Kaposi's sarcoma (KS). It has not been found in most benign and malignant cutaneous hemangioproliferative disorders other than KS. To further verify the specificity of the association of this new viral DNA with KS, we examined in total 42 cases of vascular neoplasms of endothelial derivation using nested polymerase chain reaction (PCR) for the presence of a 233-bp segment of this KSHV/HHV8 on paraffin-embedded specimens. In our investigation, we added an additional step to conventional PCR protocol that uses UV light to pretreat all the PCR regeants except Taq DNA polymerase and the target DNA to eliminate the false positives caused by trace contamination. All 15 cases of typical KS, both AIDS and non-AIDS related, as well as 4 cases of atypical vascular tumors suspicious of KS, were positive for this KSHV/HHV8 DNA sequence. The remaining 23 cases of hemangioproliferative disorders other than KS, including angiosarcoma, capillary hemangioma, angiolymphoid hyperplasia with eosinophilia, epithelioid hemangioma, histiocytoid hemangioma, hemangioendothelioma, and microvenous hemangioma, were negative for HHV8. These results confirm the previous observation that KSHV/HHV8 is specific for KS within hemangioproliferative cutaneous disorders, and PCR for detection of KSHV/HHV8 might be used as an additional diagnostic tool in distinguishing KS.

Further confirmation of the association of human herpesvirus 8 with Kaposi's sarcoma

Recently, a new herpesvirus-like DNA sequence named Kaposi's sarcoma-associated herpesvirus (KSHV) or human herpesvirus 8 (HHV8) has been isolated from almost all cases of Kaposi's sarcoma (KS). It has not been found in most benign and malignant cutaneous hemangioproliferative disorders other than KS. To further verify the specificity of the association of this new viral DNA with KS, we examined in total 42 cases of vascular neoplasms of endothelial derivation using nested polymerase chain reaction (PCR) for the presence of a 233-bp segment of this KSHV/HHV8 on paraffin-embedded specimens. In our investigation, we added an additional step to conventional PCR protocol that uses UV light to pretreat all the PCR regeants except Taq DNA polymerase and the target DNA to eliminate the false positives caused by trace contamination. All 15 cases of typical KS, both AIDS and non-AIDS related, as well as 4 cases of atypical vascular tumors suspicious of KS, were positive for this KSHV/HHV8 DNA sequence. The remaining 23 cases of hemangioproliferative disorders other than KS, including angiosarcoma, capillary hemangioma, angiolymphoid hyperplasia with eosinophilia, epithelioid hemangioma, histiocytoid hemangioma, hemangioendothelioma, and microvenous hemangioma, were negative for HHV8. These results confirm the previous observation that KSHV/HHV8 is specific for KS within hemangioproliferative cutaneous disorders, and PCR for detection of KSHV/HHV8 might be used as an additional diagnostic tool in distinguishing KS.

Transplantation-associated malignancies: restriction of human herpes virus 8 to Kaposi's sarcoma.

The human herpes virus 8 (HHV8) has been detected in all forms of Kaposi's sarcoma. HHV8 was also reported to be present in epithelial skin tumors of patients after renal transplantation, raising the question of the clinical relevance of HHV8 in transplant-related tumors. Using a highly sensitive nested polymerase chain reaction assay, we analyzed for the presence of HHV8-DNA in the tumor tissue of renal transplant recipients with Kaposi's sarcoma (n=2) and non-Hodgkin's lymphomas (n=6), and in 32 tumors from 10 patients with multiple epithelial skin tumors. HHV8-DNA was detected in both cases of Kaposi's sarcoma but not in either the non-Hodgkin's lymphomas or the epithelial skin tumors. Our data confirm the association of HHV8 with Kaposi's sarcoma but not with other transplant-related tumors. Further studies are needed to analyze the risk for transmission of HHV8 by the donor and the possible exclusion of HHV8-positive patients as organ donors.

Classic Kaposi's sarcoma on the glans penis only: Case report

The Authors report a case of Kaposi's sarcoma presenting on the glans penis only in a non-HIV positive patient, who had not been treated with immuno-suppressive drugs. In our experience and according to a review of specific literature, choice treatment would seem to be a radiotherapeutic approach followed by partial penectomy in the event of recurrence.

Kaposi's Sarcoma of the Small Intestine After Renal Transplantation: Radiological and Endoscopic Findings

A case of Kaposi's sarcoma involving the small bowel years after receiving a renal transplant is described. Immunosuppression had been achieved using cyclosporine A and prednisolone. Lesions extended from the duodenum to the ileum ; radiologically, they were demonstrated on small bowel follow-through study and computed tomography as multiple small nodular intraluminal masses with or without central umbilication, and endoscopically, were seen as intramural mucosal elevations with a central crater-like ulceration.

Primary Effusion Lymphoma in Women: Report of Two Cases of Kaposi's Sarcoma Herpes Virus-Associated Effusion-Based Lymphoma in Human Immunodeficiency Virus-Negative Women

Recent molecular evidence suggests an association with a new herpes virus, Kaposi's sarcoma-associated herpes virus (KSHV/HHV-8), and primary effusion lymphomas (PEL). PELs have a characteristic morphology, phenotype, and clinical presentation with malignant effusions in the absence of a contiguous solid tumor mass. Most cases of PEL have occurred in human immunodeficiency virus (HIV)-positive male patients who are coinfected with Epstein-Barr virus (EBV). This report describes two cases of PEL in HIV- and EBV-negative women. In one patient, a pleural cavity PEL was preceded by classic Kaposi's Sarcoma (KS) of the lower extremities. In the second patient, PEL developed in an artificial cavity related to the capsule of a breast implant. Both cases had the characteristic morphologic appearance of high-grade anaplastic/B-cell immunoblastic lymphomas, with loss of B-cell differentiation antigens, clonal immunoglobulin heavy chain gene rearrangements, and expression of activation antigen CD30. Both cases were negative for EBV, herpes virus simplex, and cytomegalovirus (CMV). DNA extracted from both lymphomas and skin KS specimen showed KSHV sequences by molecular analysis. This report expands the spectrum of KSHV-associated disease to include PEL in HIV-negative women.

Two cases of Kaposi's sarcoma in renal and liver transplant recipients treated with interferon

We report two cases of Kaposi's sarcoma in recipients of solid organ transplants, presenting (Case 1) 12 months after liver transplantation and (Case 2) 7 months after kidney transplantation. Both patients share the following features: natives from the Mediterranean area (Southern Italy), multiple immunosuppressive regimen, infection with hepatitis B and cytomegalovirus. During the 3 yr of follow‐up after the diagnosis, their immunosuppressive regimen was reduced and they were treated with alpha interferon with remission of the clinical findings. The management of Kaposi's sarcoma in organ transplant recipients remains a controversial issue because of the risks of organ rejection associated with the reduction of immunosuppression and with the use of interferon.

Use of the in vitro induced antibody production test (IVIAP) to elucidate inconclusive status of HIV-1 infection

Studies have demonstrated the diagnostic usefulness of in vitro production of virus-specific antibodies by peripheral blood mononuclear cells (PMBC) from HIV-infected subjects. We evaluated the IVIAP (in vitro induced antibody production) by lympocytes from peripheral blood of 30 adult patients. Samples included 10 patients with inconclusive status of HIV-1 infection on previous serologic screening (2 blood donors, 8 with high risk behavior), 10 AIDS patients (CDC II–IV), and 10 known seronegative subjects. Positive IVIAP results were obtained on 2 of 10 inconclusive cases, earlier than seroconversion would demonstrate. The 8 remaining cases resulted in a negative outcome on IVIAP test, even in 2 seronegative homosexuals presenting Kaposi's sarcoma. Results showed 100% concordance either with a clinical/serological follow-up done after IVIAP tests or PCR performed for Kaposi's cases. Also, no false-positive or false-negative was detected on control groups. We concluded that IVIAP could identify the real status of HIV infection in a shorter time and with low cost compared to conventional serological methods currently available. The IVIAP test is easily performed so that can be considered as a routine supplemental test.

Expression of the CD34 antigen distinguishes Kaposi's sarcoma from pseudo-Kaposi's sarcoma (acroangiodermatitis)

The differential diagnosis between Kaposi's sarcoma and the so-called 'pseudo-Kaposi's sarcoma' or acroangiodermatitis of the feet is often fraught with difficulty, not only on clinical but also on histological grounds. The aim of this study was to assess whether immunolabelling for the CD34 antigen, a marker of Kaposi's sarcoma cells, could be of value in the distinction between these two angioproliferative disorders. We comparatively examined 16 biopsy specimens from cases of Kaposi's sarcoma and seven biopsies from patients with pseudo-Kaposi's sarcoma, by a streptavidin-biotin-peroxidase method, using a monoclonal antibody to the CD34 antigen. All cases of Kaposi's sarcoma showed CD34 labelling both on endothelial cells and on the characteristic spindle-shaped, perivascular cells. Biopsies of pseudo-Kaposi's sarcoma showed a strong labelling of endothelial cells of hyperplastic vessels. However, in sharp contrast with Kaposi's sarcoma, a complete absence of perivascular CD34 expression was noted. It seems therefore that immunolabelling for the CD34 antigen appears to be a valuable tool in the differential diagnosis between Kaposi's sarcoma and pseudo-Kaposi's sarcoma.

Major basement membrane components in Kaposi's sarcoma, angiosarcoma and benign vascular neogenesis

Recent cell biologic studies have emphasized the importance of the basement membrane (BM) and its molecular components in angiogenesis. We immunostained 60 angioproliferative lesions (angiosarcoma, sclerosing hemangioma of skin, pyogenic granuloma, capillary hemangioma, lymphangioma, glomangioma and granulation tissue) and 23 cases of Kaposi's sarcoma (KS) for the major macromolecular components laminin, collagen type IV, fibronectin and heparan sulfate proteoglycan (HSPG). Normal structures served as aggregate controls in each group, and semiquantitative scoring reflected the degree of consistency of staining about blood and lymphatic endothelium and vascular sheath (pericyte/smooth muscle) within and peripheral to each lesion. Benign and reactive vasoproliferations consistently maintained immunoreactivity for each BM component around endothelium and sheath components of blood vessels. Angiosarcoma showed from 20 to more than 60% less consistent immunoreactivity by comparison, although the score variances were greater than for non-malignant lesions. Staining about blood vessel endothelium was both strong and consistent among histologic stages in KS with the exception of HSPG, which was weakly immunoreactive in all stages. Marked selective HSPG loss was characteristic only of KS and normal lymphendothelium, and in the light of evidence for a role for HSPG in the assembly and maintenance of BM, suggests that reduced HSPG may be responsible for the loss of ultrastructural integrity of perivascular BM in both.

Kaposiʼs Sarcoma With Elephantiasis Associated With AIDS

Nurses in many parts of the United States have limited experience in caring for patients with Kaposi's sarcoma. The severity of the disease can range from a few lesions to extensive cases with fungating, encrusted wounds. This case study describes the wound management of a 43-year-old patient with an advanced case of Kaposi's sarcoma with elephantiasis of the lower extremities. Use of a collaborative care approach resulted in dramatic improvement of this patient's wounds. Although the patient's serum albumin level remained low, no secondary skin breakdown or infection occurred.

Poppers, Kaposi′s-Sarcoma, and HIV-Infection: Empirical Example of a Strong Confounding Effect?

Are there empirical examples of strong confounding effects? Textbooks usually show examples of weak confounding or use hypothetical examples of strong confounding to illustrate the paradoxical consequences of not separating out the effect of the studied exposure from that of second factor acting as a confounder. HIV infection is a candidate strong confounder of the spuriously high association reported between consumption of poppers, a sexual stimulant, and risk of Kaposi′s sarcoma in the early phase of the AIDS epidemic. To examine this hypothesis, assumptions must be made on the prevalence of HIV infection among cases of Kaposi′s sarcoma and on the prevalence of heavy popper consumption according to HIV infection in cases and controls. Results show that HIV infection may have confounded the poppers-Kaposi′s sarcoma association. However, it cannot be ruled out that HIV did not qualify as a confounder because it was either an intermediate variable or an effect modifier of the association between popper inhalation and Kaposi′s sarcoma. This example provides a basis to discuss the mechanism by which confounding occurs as well as the practical importance of confounding in epidemiologic research.

Cell Wall Deficient Forms—Stealth Pathogens

A comprehensive text-reference which covers major aspects of cell wall deficient microbes (L forms). The book discusses protoplasts as efficient genetic tools, L forms essential to the food chain for their ability to reclaim nitrogen in the air, an L form pathogenic to a flowering plant, and new information on male sterility caused by streptococcal L forms in drosphila. This new edition covers the L forms implicated in sarcoidosis, chronic stages of rheumatoid arthritis, uveitis, Crohn's disease, and Whipple's disease. AIDs-related data covered includes micrographs of an agent found in six Kaposi cases that resembles clinical L forms. The book presents methods for rapid diagnosing of common serious infections such as tuberculosis; describes little-known characteristics of mycobacterium leprae, including optimum temperature and pH. The book is aimed at haematologists, cellular biologists, microbiologists and clinical laboratory personnel.

Risk of other cancers following Kaposi's sarcoma: relation to acquired immunodeficiency syndrome.

To evaluate the risk of another cancer among persons who initially developed Kaposi's sarcoma, the authors used data from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute for the years 1973-1990. In persons under 70 years of age, 4,946 cases of Kaposi's sarcoma were observed during the period 1980-1990 (6,217 person-years of follow-up). On the basis of rates seen during the period prior to the epidemic of acquired immunodeficiency syndrome (AIDS), 169 cases were expected. Therefore, cases of Kaposi's sarcoma in this group were assumed to be AIDS-related, while cases occurring in older persons or during the 1970s were assumed to be non-AIDS-related. Rates were compared with the numbers of cases expected overall and by site on the basis of age-, sex-, and calendar year-specific rates from the SEER data. Among the 4,946 persons with AIDS-related Kaposi's sarcoma, the risk of developing non-Hodgkin's lymphoma through 1990 was increased 198-fold (95% confidence interval 169-232). However, the risk of all other cancers was only marginally increased (1.5-fold; 95% confidence interval 0.95-2.3), a risk that was probably biased upward because of ascertainment and misclassification. Among 491 persons with non-AIDS-related Kaposi's sarcoma, the relative risk of all cancers, including non-Hodgkin's lymphoma, was 0.9 (upper 95% confidence limit 1.2), and the risk of non-Hodgkin's lymphoma alone was 0.6 (upper 95% confidence limit 3.3). As of 1990, the risk of having another cancer following Kaposi's sarcoma was increased only in persons infected with human immunodeficiency virus, who were at high risk of non-Hodgkin's lymphoma but probably not of other cancers as a whole.

Kaposi's sarcoma of the bone marrow presenting with fever of unknown origin

Kaposi's sarcoma (KS) has become more common in the United States with the spread of the Acquired Immunodeficiency Syndrome (AIDS) epidemic. The epidemic form associated with AIDS involves primarily skin and visceral organs. Bone marrow involvement is rare. We present a case of Kaposi's sarcoma that was diagnosed upon bone marrow biopsy, without skin or visceral involvement, that presented with fever of unknown origin which responded to indomethacin and anti-KS chemotherapy. Kaposi's sarcoma of the bone marrow should be considered in the differential of febrile illness of unknown origin in patients with AIDS.

Malignant Tumours of the External Ear

CH Karsli, OM Antonyshyn, CR Forrest, D Assaad, I Ackerman. Malignant tumours of the external ear. Can J Plast Surg 1994;1(4): 177-183. This study employs a retrospective chart review to describe the demographic features, clinical presentation and treatment of malignant tumours of the external ear. This series includes 129 tumours of the external ear in as many consecutive patients presenting to the Toronto Bayview Regional Cancer Centre between January 1986 and December 1991. Sixty-seven per cent of those tumours were basal cell carcinomas, 32% were squamous cell carcinomas, and a single case of Kaposi's sarcoma was encountered. The majority of patients was male and the mean age was 70.1 years. The helical rim was the most common site of involvement, followed by the postauricular, conchal and antihelical regions. Small tumours were located in the visually obvious areas of the ear, namely the helix and lobule, whereas larger tumours were found in the deeper central portions such as the concha and external auditory meatus. Twelve per cent of squamous cell carcinomas were metastatic at the time of treatment. Treatment methods included electrodesiccation and curettage, surgical excision with or without frozen sections, radiotherapy or combination therapy. Surgical excision, with frozen section control in carefully selected cases, remains the treatment of choice for the majority of external ear tumours. Various methods of reconstruction of the resulting defects are described.

Le sarcome de kaposi de présentation extra-cutanée au cours du sida: 20 observations

We report a retrospective analysis of 20 cases of Kaposi's sarcoma in AIDS presenting without cutaneous involvement at diagnosis. This complication occurs in advanced stages of HIV infection, with low CD4+ T cell counts. The most frequent localizations are gastrointestinal and respiratory. Response to therapy is poor.

Relations entre maladie de Kaposi et hormones sexuelles. A propos d'une observation privilégiée et revue de la littérature

The authors report a case of Kaposi's sarcoma (KS) in a HIV-negative bisexual man while receiving androgen therapy; they dicuss the role of androgens in the development of KS, and explain the arguments in the litterature in favor fo a role of sex hormones in the pathogenesis of KS.

Population-based study of malignancies and HIV infection among injecting drug users in a New York City methadone treatment program, 1985-1991.

To study the incidence of AIDS-defining and non-AIDS-defining malignancies in injecting drug users with and without HIV infection in a methadone maintenance treatment program (MMTP). Prospective study within a hospital-affiliated MMTP with on-site primary medical services. The MMTP has been the site of a voluntary longitudinal cohort study of HIV infection since 1985. Active surveillance for all new cancer cases occurring among patients in the MMTP between July 1985 and August 1991. Cancer cases were identified by review of clinic and hospital records, hospital-based tumor registries, and New York City vital records. Cancer incidence was determined for the overall MMTP population and for HIV-seropositive and HIV-seronegative cohort study subgroups. During the study period the MMTP population comprised 2174 patients followed for 5491 person-years; 844 patients (380 HIV-seropositive, 464 HIV-seronegative) also participated in the cohort study. Fifteen non-AIDS-defining malignancies occurred among all MMTP patients (2.73 cases per 1000 person-years); the most frequent sites were lung, larynx, and cervix (n = 6, 2 and 2, respectively). Eighty per cent of patients with these cancer diagnoses and known HIV serologic status were seropositive. Within the cohort study group, six out of 380 HIV-seropositives developed non-AIDS-defining cancers versus one out of 464 HIV-seronegatives (P = 0.05, Fisher's exact test). Lung cancer cases in HIV-seropositive patients tended to occur at an earlier age and was more aggressive than in patients with HIV-seronegative or unknown status. During the same period, two cases of AIDS-defining lymphoma and one case of Kaposi's sarcoma were diagnosed in the MMTP population (0.5 cases per 1000 person-years). Solid neoplasms, while infrequent, were associated with HIV infection and were more common than AIDS-defining cancers in this population of drug injectors. Further study is needed to explore the relationship between HIV, behavioral factors, and cancer risk in injecting drug users.