Extensive Kaposi Research Articles

Extensive Kaposi's sarcoma in a Patient with Acquired Immunodeficiency Syndrome: Case Report

Kaposi's Sarcoma (KS) is an angioproliferative neoplasm, the causative agent is human herpes virus 8 and the second most frequent tumor after non-Hodgkin lymphoma related to the human immunodeficiency virus (VIH). We present the case of a 40-year-old male with no history of chronic diseases, who began his condition with adenopathies in the bilateral inguinal region, adding a productive cough, lymphedema, and skin lesions with nodular characteristics and bleeding ulcers. A positive HIV test was reported, and a biopsy was performed, showing evidence of a spindle cell neoplasm compatible with KS. Laboratories with hemoglobin 8.3 mg/dL, platelets 239,000/uL, leukocytes 7.29/uL, glucose 76 mg/dL, creatinine 2.2 mg/dL, urea 80 mg/dL, albumin 1.69 g/dL, TGO 18 IU/L, TGP 5 IU/L, DHL 189 IU/L, viral load 283,259 copies and CD4 192 cells. Chest and abdomen computed tomography with evidence of pleural effusion, and multiple retroperitoneal and inguinal adenopathies. Starting concomitant retroviral treatment with liposomal doxorubicin, improving clinical status and laboratory parameters. HIV-infected people are at high risk of developing KS, early initiation of antiretroviral therapy, and maintenance of high CD4 cell counts are essential to reduce the incidence.

Extensive Kaposi's sarcoma in a Patient with Acquired Immunodeficiency Syndrome: Case Report

Extensive Kaposi's sarcoma in a Patient with Acquired Immunodeficiency Syndrome: Case Report

KAPOSI SARCOMA IN AN IMMUNOSUPPRESSED PATIENT WITH PRESUMED CROHN’S DISEASE: IATROGENIC OR EPIDEMIC?

Biologic immunosuppression and HIV infection both carry risks of infection and malignancy. Small series suggest that patients living with well-controlled HIV may safely and efficaciously use biologics, like TNF-alpha inhibitors (TNF-I). However, no current U.S. guidelines exist to screen for HIV infection among high-risk groups prior to starting TNF-I. We describe the case of a patient who received TNF-I for Crohn’s Disease without any HIV testing, who developed potentially avoidable extensive Kaposi Sarcoma.

KAPOSI SARCOMA IN AN IMMUNOSUPPRESSED PATIENT WITH PRESUMED CROHN’S DISEASE: IATROGENIC OR EPIDEMIC?

Abstract Introduction Biologic immunosuppression and HIV infection both carry risks of infection and malignancy. Small series suggest that patients living with well-controlled HIV may safely and efficaciously use biologics, like TNF-alpha inhibitors (TNF-I). However, no current U.S. guidelines exist to screen for HIV infection among high-risk groups prior to starting TNF-I. We describe the case of a patient who received TNF-I for Crohn’s Disease without any HIV testing, who developed potentially avoidable extensive Kaposi Sarcoma. Case Description A healthy 32-year-old man presented with 1 month of diarrhea and a 15-lb weight loss. Fecal calprotectin, ESR, and CRP were markedly elevated. Endoscopy demonstrated severe rectal inflammation with perirectal abscess and perianal skin tags, suggestive of inflammatory bowel disease. Biopsies showed active colitis with ulceration, cryptitis, and fibropurulent debris without evidence of granulomata, dysplasia, or CMV. He was treated with IV antibiotics, IV steroids, and 2 infusions of infliximab at 5 mg/kg. He continued to have 4 loose stools an hour, limiting his steroid wean. One month later, he developed painful, violaceous plaques on his face, buccal mucosa, torso, and lower extremities. Biopsy showed Kaposi Sarcoma, and HIV test was positive, with viral load 3292 and CD4 count 248. Although in a monogamous relationship with his husband, a well-recognized risk factor for HIV acquisition, he had never been tested for HIV. Antiretroviral therapy was initiated promptly. Repeat rectal biopsies stained positive for HHV-8 and CMV, concerning for rectal KS and CMV proctitis. He started valgancyclovir but self-increased prednisone, with poor symptom relief. Review of the initial endoscopy confirmed no obvious HHV-8 positivity. Three weeks after HIV diagnosis, he developed new red nodules across his chest, suspicious for worsening KS due to immune reconstitution inflammatory syndrome (IRIS). He completed 12 cycles of chemotherapy and had no sign of residual IBD on recent colonoscopy. KS is his presumed original diagnosis. Discussion Current U.S. guidelines do not recommend HIV screening prior to TNF-I use, despite the heightened risks of cumulative immune dysregulation. Our patient should have been screened annually for HIV according to CDC guidelines. Further, his uncontrolled HIV infection in combination with TNF-I and high dose steroids led to life-threatening Stage IV malignancy (KS), complicated by immune reconstitution inflammatory syndrome and poor ART absorption. We propose that all patients should be screened for common risk factors for HIV acquisition, such as men who have sex with men or intravenous drug use. For high risk patients, gastroenterologists should consider screening for HIV, in addition to tuberculosis and hepatitis, prior to immunosuppression with TNF-I.

969. TNF-alpha inhibition in the setting of undiagnosed HIV infection: a call for enhanced screening guidelines

BackgroundDespite the risks of immunosuppression, recommendations regarding screening for HIV infection prior to initiation of biologic therapies targeting common autoimmune disorders, including inflammatory bowel disease (IBD) and inflammatory arthritides, are limited. Few cases of patients started on biologics while living with undiagnosed HIV have been reported.MethodsWe report 3 cases of patients initiated on biologics in the absence of recent or concurrent HIV screening who developed refractory disease or unanticipated complications and were later found to have undiagnosed chronic HIV infection.ResultsIn Case 1, a 53-year-old man who has sex with men (MSM) with negative HIV testing 10 years prior presented with presumed rheumatoid arthritis. He did not respond to methotrexate (MTX), so adalimumab (ADA) was started. HIV testing to evaluate persistent symptoms was positive 9 months later; CD4 was 800 cells/uL. Antiretroviral therapy (ART) resulted in resolution of symptoms, which were attributed to HIV-associated arthropathy.In Case 2, a 55-year-old woman with injection drug use in remission and no prior HIV testing presented with Hidradenitis Suppurativa (HS). She was initiated on infliximab (IFX) and MTX with good response. After she developed weight loss and lymphopenia, an HIV test was positive; CD4 was 334 cells/uL. Biologic HS therapy was discontinued, with subsequent poor HS control.In Case 3, a 32-year-old MSM with no prior HIV testing presented with presumed IBD; IFX and steroids were started. Symptoms progressed despite IBD-directed therapy, and he was diagnosed with extensive Kaposi Sarcoma (KS) with visceral and cutaneous involvement likely exacerbated by immunosuppression. HIV testing was positive; CD4 was 250 cells/uL. KS initially worsened due to ART-associated immune reconstitution inflammatory syndrome. He is now improving with systemic chemotherapy and ART. HIV-associated KS is presumed to be hte underlying diagnosis.ConclusionAll 3 patients had elevated risk for HIV infection, and 2 had final diagnoses attributed to chronic HIV infection, not warranting therapeutic immunosuppression. Screening for HIV infection prior to initiation of biologic therapy should be incorporated into clinical practice guidelines.Disclosures All Authors: No reported disclosures

Extensive Kaposi sarcoma in a young adult with Wiskott–Aldrich syndrome

Extensive Kaposi sarcoma in a young adult with Wiskott–Aldrich syndrome

Gastrointestinal Kaposi Sarcoma with Appendiceal Involvement

Kaposi sarcoma is a vascular tumor manifesting as nodular lesions on skin, mucous membranes, or internal organs. This is a case of a 42-year-old human immunodeficiency virus- (HIV) positive bisexual male, not on highly active antiretroviral therapy (HAART) since diagnosis four years ago. He presented with a three-day history of abdominal pains, fever, vomiting, and a one-week history of melena stools. Endoscopy revealed Kaposi sarcoma in the stomach and duodenum. Postendoscopy, he developed acute abdomen. Exploratory laparotomy revealed extensive Kaposi sarcoma of the gastrointestinal tract with appendiceal involvement. The patient underwent appendectomy and had an uneventful recovery. A review of the literature discusses appendiceal Kaposi sarcoma with appendicitis, a rare but critical manifestation of gastrointestinal Kaposi sarcoma.

Extensive Kaposi's sarcoma in a HIV positive patient: A case report

Extensive Kaposi's sarcoma in a HIV positive patient: A case report

Penile gangrene associated with extensive kaposi's sarcoma in patients with the acquired immunodeficiency syndrome

Kaposi's sarcoma (KS) of the penis is a well-recognized manifestation of the acquired immunodeficiency syndrome. Extensive KS of the genitalia progressed and caused penile gangrene in 2 cases. Management is palliative with urinary diversion via percutaneous suprapubic cystostomy.

Intolerable Pruritis in an HIV-Infected Man

Angel C. is a 40-year old HIV-infected man for whom you have been caring since his initial episode of PCP almost four years ago. He has extensive Kaposi's sarcoma, disseminated MAC, and is quite debilitated. Since his last hospitalization for a severe bacterial pneumonia, he has been living at home with a rotation of health aides. He has expressed the wish for comfort-directed medical care only from now on. Mr. C. comes to see you for a routine appointment complaining of a terrible itch all over his body. The aide accompanying him confirms that Mr. C. has been scratching nonstop for almost two weeks, despite a variety of over-the-counter skin creams they have tried. Mr. C. went to see a dermatologist in his neighborhood last week, who provided several sample-sized tubes of a steroid cream. This medication helped the itch somewhat, but Mr. C. has used up his supply and begs you to write him a prescription for more. Reviewing Mr. C.'s chart, you confirm that the only medications he is taking are those he's been …

Mycobacterium haemophilum infection in a patient with AIDS

We report the isolation of a nutritionally fastidious mycobacterial species, Mycobacterium haemophilum, from the skin of a patient with AIDS. The diagnosis of the mycobacterial nature of the patient's lesions was complicated by extensive Kaposi's sarcoma. It is recommended that slowly growing fastidious mycobacteria be sought in any patients with unusual skin lesions.

Systemic treatment of AIDS-related Kaposi's sarcoma: Results of a randomized trial

Patients with acquired immunodeficiency syndrome (AIDS)-related epidemic Kaposi's sarcoma generally respond well to cytotoxic chemotherapy. However, due to the associated myelosuppression, these patients are at risk for developing complicating infections that may affect survival. We therefore conducted a multi-center randomized clinical trial comparing single-agent against combination chemotherapy in advanced AIDS-related Kaposi's sarcoma. Low-dose chemotherapy was employed to evaluate its role in combination therapy for this disease and the toxicities associated with the lower intensity. Sixty-one patients with extensive mucocutaneous Kaposi's sarcoma or visceral involvement were randomized for treatment with low-dose Adriamycin (doxorubicin, 20 mg/m2) alone (31 cases) or in combination with bleomycin and vincristine (ABV) (30 cases). Patients were randomized within strata based on prognostic features associated with shorter survival in prior studies. Both treatment arms were evenly matched at study entry. Complete and partial tumor remissions were significantly higher with ABV (88%) than with Adriamycin alone (48%) (p = 0.004). The median survival was 9 months in both groups. Study entry criteria significantly associated with shorter survival included CD4 lymphocyte counts less than 100/mm3, hemoglobin level less than 10 g/dL, a history of constitutional symptoms, and a prior history of opportunistic infection(s). Toxicities were similar in both arms, and the regimens were well tolerated. Neutropenia (granulocyte count less than 1,000/mm3) occurred in 34% of patients receiving Adriamycin alone and in 52% of patients receiving ABV and was progressive in successive courses of chemotherapy in both treatment arms. The development of AIDS-defined opportunistic infections was relatively infrequent during therapy (14%). Low-dose ABV is an effective chemotherapy regimen for the treatment of extensive Kaposi's sarcoma. ABV chemotherapy is associated with significantly higher responses than Adriamycin alone and with acceptable toxicity.

Systemic treatment of AIDS-related kaposi's sarcoma: Results of a randomized trial

purpose: Patients with acquired immunodeficiency syndrome (AIDS)-related epidemic Kaposi's sarcoma generally respond well to cytotoxic chemotherapy. However, due to the associated myelosuppression, these patients are at risk for developing complicating infections that may affect survival. We therefore conducted a multicenter, randomized clinical trial comparing single-agent against combination chemotherapy in advanced AIDS-related Kaposi's sarcoma. Lowdose chemotherapy was employed to evaluate its role in combination therapy for this disease and the toxicities associated with the lower intensity. patients and methods: Sixty-one patients with extensive mucocutaneous Kaposi's sarcoma or visceral involvement were randomized for treatment with low-dose Adriamycin (doxorubicin, 20 mg/m 2) alone (31 cases) or in combination with bleomycin and vincristine (ABV) (30 cases). Patients were randomized within strata based on prognostic features associated with shorter survival in prior studies. Both treatment arms were evenly matched at study entry. results: Complete and partial tumor remissions were significantly higher with ABV (88%) than with Adriamycin alone (48%) (p = 0.004). The median survival was 9 months in both groups. Study entry criteria significantly associated with shorter survival included CD4 lymphocyte counts less than 100/mm 3, hemoglobin level less than 10 g/dL, a history of constitutional symptoms, and a prior history of opportunistic infection(s). Toxicities were similar in both arms, and the regimens were well tolerated. Neutropenia (granulocyte count less than 1,000/ mm 3) occurred in 34% of patients receiving Adriamycin alone and in 52% of patients receiving ABV and was progressive in successive courses of chemotherapy in both treatment arms. The development of AIDS-defined opportunistic infections was relatively infrequent during therapy (14%). conclusions: Low-dose ABV is an effective chemotherapy regimen for the treatment of extensive Kaposi's sarcoma. ABV chemotherapy is associated with significantly higher responses than Adriamycin alone and with acceptable toxicity.

Treatment of Advanced Kaposiʼs Sarcoma Using a Combination of Bleomycin and Vincristine

Eighteen patients with disseminated AIDS-related Kaposi's sarcoma (KS) and compromised bone marrow function were treated with a relatively non-myelosuppressive regimen of bleomycin and vincristine (BV). At study entry, the patients presented with the following median laboratory values: hemoglobin of 9.5 g/dl, granulocyte counts of 1,173/mm3, platelet counts of 218,000/mm3, and CD4 lymphocyte counts of 58/mm3. All patients had extensive Kaposi's sarcoma. Nine patients had visceral involvement: four with pulmonary involvement, two with gastrointestinal involvement, and three with both. Following a median number of seven cycles of biweekly chemotherapy, complete or partial tumor responses were achieved in 13 patients (72%). Two patients experienced bleomycin-induced skin toxicities, whereas 10 others (55%) experienced peripheral sensory neuropathy requiring vincristine dose reductions. Opportunistic infections had occurred in 11 patients prior to initiation of chemotherapy and in 16 after initiation of chemotherapy. Despite the frequent development of opportunistic infections, BV chemotherapy was relatively well tolerated and resulted in a high response rate in this patient population that presented with suboptimal marrow function and extremely low CD4 lymphocyte counts.

Lymphangioscintigraphy in AIDS-associated Kaposi sarcoma.

Kaposi sarcoma, a common opportunistic neoplasm complicating AIDS, is thought to arise from the vasculature and possibly from lymphatic endothelium. To evaluate the nature and extent of lymphatic involvement in AIDS-associated Kaposi sarcoma, we used an improved technique of whole-body lymphangioscintigraphy. Six human-immunodeficiency-virus-seropositive men (40-51 years old) with AIDS and extensive Kaposi sarcoma had bilateral foot and/or hand intradermal injection of 0.05 ml of 99mTc-labeled human serum albumin (500 microCi, 18.5 MBq). After sequential whole-body scanning with a digital gamma camera, the findings were interpreted by comparing them with findings from similar studies in 30 other patients without AIDS or Kaposi sarcoma (26 with primary or secondary lymphedema and four with normal extremities). Unlike in normal limbs, where lymphangioscintigraphy displayed early lymphatic truncal and regional nodal filling with radionuclide, in patients with Kaposi sarcoma, lymphangioscintigraphy disclosed a variety of abnormal patterns with some features distinct and others resembling lymphatic dysplasia as seen in primary and secondary lymphedema. These included focal accumulation of tracer within lymphatic channels in the distribution of cutaneous Kaposi lesions; delayed tracer transport with absent, faint, or intense regional lymph nodal uptake; and retarded or impeded lymphatic drainage with tracer intensification in the region of Kaposi sarcoma plaques. The impaired lymphatic drainage and nodal dysfunction seen on scintigrams in patients with AIDS-associated Kaposi sarcoma suggest a close connection between the lymphatic system and this disorder.

Autopsy findings in AIDS-related lymphoma.

Autopsies in 20 patients with the acquired immune deficiency syndrome (AIDS)-related lymphoma were studied retrospectively to ascertain the precise cause of death and the extent of lymphomatous disease. Eight patients had primary central nervous system (CNS) lymphoma: two of them were diagnosed antemortem; CNS lymphoma was suspected in three others by computerized tomographic (CT) scan and was confirmed at autopsy. The remaining three were diagnosed incidentally at autopsy. All had concurrent infections at autopsy, including opportunistic infection in six and pyogenic infections in two. Opportunistic infections at autopsy in these patients outnumbered those diagnosed clinically. Twelve patients had systemic lymphoma. Three were diagnosed only at autopsy, two of whom had extensive Kaposi's sarcoma (KS) as well. Eight patients were treated with chemotherapy, but died with disseminated disease. Opportunistic infections were found at autopsy in five patients. Secondary involvement of the CNS by lymphoma was frequent (66%) and was not related to previous bone marrow involvement. The authors conclude that the incidence of lymphoma occurring in AIDS may be more frequent than diagnosed clinically. Similarly, multiple opportunistic infections occur in these patients which are not diagnosed premortem and may contribute to early death.

6 MeV rotational therapy with a midline shield for superficial skin tumors.

A 6 MeV photon energy rotational beam with a midline lead shield is applied to the convex surface of the lower extremity in the treatment of extensive Kaposi's sarcoma. Such innovation is conducive to uniform surface dose distribution with the smallest possible depth dose to deep-lying structures at this energy level. A case example and computerized composite isodose printouts are presented.