Kaposi's Disease Research Articles

Myeloma Cast Nephropathy Complicating Multiple Myeloma Associated with Kaposi Sarcoma: Is This a New Victim of Human Herpes Virus Type 8? Case Report

Kaposi sarcoma (KS) is an angiogenic neoplasia characterized primarily by purplish to brownish skin lesions. Most often linked to infection by human herpes virus type 8 (HHV8), it affects men more than women and has especially been found in elderly people around the Mediterranean. Classic Kaposi sarcoma is rare and the association with multiple myeloma (or Kahler's disease) remains exceptional with a few cases sporadically described in the literature. We report a new case illustrating this association. This is a 70-year-old patient in whom classic Kaposi disease was recently diagnosed by skin biopsy with positive HHV8 serology. He was subsequently referred to the Department of Nephrology due to the fortuitous discovery of severe kidney failure with a renal biopsy in favour of myeloma light chain cast nephropathy. The hypothesis incriminating an HHV8 variant in the pathogenesis of multiple myeloma is known in the literature but not yet elucidated. It is therefore of great interest that clinicians be sensitized about this association in order to progress in research and improve treatment and prognosis.

Atypical Presentation of Classic Kaposi's Disease: About a New Observation

Atypical Presentation of Classic Kaposi's Disease: About a New Observation

Epidemiological profile of tumor dermatoses in the hospital setting in Cotonou (Benin) from 2009 to 2018

Introduction Tumoral dermatoses are tissue neoformations due to an excessive, abnormal, anarchic and more or less autonomous cellular proliferation at the expense of the skin and its appendages. These tumoral dermatoses can be benign or malignant. They are responsible for a high morbi-mortality. Patients and methods Retrospective and descriptive cross-sectional study of the records of patients seen for mucocutaneous tumors, in the Dermatology-Venereology Department of the National Hospital and University Center Hubert Koutoukou Maga (NHUC-HKM) of Cotonou, from 2009 to 2018. Epidemiological data were collected from consultation registers and then entered and analyzed with Excel, EPI-DATA and SPSS software. Results A total of 10,627 new patients were registered, of which 885 cases of tumor dermatoses (8.32%). Thirty-five types of tumor dermatoses were collected. The average age was 31 years; the most represented age group was 20-39 years (46.30%). The sex ratio was 1.02. Lesions were acquired in 93.30% of patients. Benign tumors represented 94.80% of the patients. They were dominated by keloids (24.60%) followed by condylomas (16.20%), warts (10.40%), molluscum contagiosum (7.60%), cysts (6.50%) and the group formed by nevi and hamartomas (6.20%). Malignant tumors were rare and represented by carcinomas (basal and squamous cell) with 1.7% and melanoma (0.50%). Kaposi's disease was observed in 2.50%. Conclusion This study allowed us to know the frequency and the different types of tumoral dermatoses observed in the patients followed in the dermatology-venereology department of the NHUC-HKM of Cotonou during the last ten years.

Une présentation cutanée inhabituelle de la maladie de Kaposi: un nodule plantaire solitaire

Kaposi's disease is a polyclonal tumor originating by chronic proliferations of Human Herpesvirus-8 (HHV-8) infected fusiform and endothelial cells. Endemic or african Kaposi's disease manifests in adults as angiomatous or pigmented nodules, macules or patches associated with bilateral lymphoedema of the legs and feet. We here report a case of epidemic Kaposi’s disease in an adult patient who presented with an unusual clinical manifestation of the disease: a solitary fleshy plantar nodule. The study involved a 68-year-old woman come to consultation in the department of dermatology with a painless plantar nodule, sometimes bleeding after trauma, which had evolved over the previous year. Physical examination showed a single rounded, angiomatous plantar nodule, measuring 3 cm along its longer axis, surrounded by a desquamative crown. The remainder of the physical examination was normal. Diagnostic hypotheses included eccrine poroma, botryomycoma and achromic melanoma. Complete excisional biopsy of the nodule was performed. Histological examination of the specimen showed tumor proliferation of fusiform cells associated with neocapillaries. This suggested Kaposi's disease. Immunostaining could not be performed as it was not available in our working environment. Our case is original because of an unusual clinical manifestation of epidemic Kaposi's disease, a solitary plantar nodule, that can be confused with botryomyoma and eccrine poroma.

Un nodule de la face : présentation inhabituelle de maladie de Kaposi révélant une infection par le VIH

Cutaneous Kaposi's disease usually presents as purplish macules and papules. Only when the disease progresses do nodules appear. We report here a case with an initial presentation of nodules on the hemiface, revealing HIV infection.

Mortality disparities among patients with HIV-associated Kaposi's sarcoma in the southern United States.

To describe risk factors for mortality in HIV-associated Kaposi's sarcoma in an urban population in Dallas, Texas. Retrospective electronic medical record review of patients with HIV-associated Kaposi's sarcoma. Electronic medical records were reviewed from 1 January 2009 to 31 December 2018 for patients with a diagnosis of HIV and Kaposi's sarcoma by ICD-9 or ICD-10 codes. Demographics, HIV history, Kaposi's sarcoma history, treatment, and mortality data were collected. Mortality data was supplemented by an inquiry from the National Death Index (NDI). Survival analyses were performed using Cox proportional hazards analysis to determine independent predictors of mortality. Black patients had higher mortality than white or Hispanic patients (hazard ratio 2.07, 95% confidence interval 1.12-3.82), even after adjusting for covariates. This mortality difference correlates with higher rates of advanced Kaposi's sarcoma disease and KS-IRIS in black patients compared with other groups and is not explained by differences in CD4+ cell count, HIV viral load, engagement in care, or ART adherence at the time of cancer diagnosis. Despite nationwide trends showing decreased incidence and decreased mortality in Kaposi's sarcoma in the ART era, a high number of Kaposi's sarcoma cases and disparities in Kaposi's sarcoma outcomes persist in certain populations in the United States.

Place de la radiothérapie dans le traitement des carcinomes cutanés

Basal cell carcinomas and cutaneous squamous cell carcinomas are among the most common cancerous tumors in the world. Their treatment is most often based on surgery. Adjuvant radiotherapy may be indicated in case of risk factors for recurrence or as an alternative to surgery if surgery is not feasible due to the patient's advanced age and/or co-morbidities or as an alternative to potentially mutilating surgery. Radiotherapy is also part of the therapeutic arsenal for rarer skin tumors such as Merkel cell carcinoma, cutaneous lymphomas, Kaposi's disease and cutaneous adnexal carcinomas.

Kaposi's sarcoma revealing an immune restoration syndrome

Introduction: Highly active antiretroviral therapy (HAART) leads to reconstitution of immune responses in HIV-infected patients. This immune reconstitution may reveal an immune reconstitution syndrome (IRS). While tuberculosis is the most common manifestation of IRS in southern countries, other more serious conditions such as Kaposi's disease may reveal it. Observation: We report a case of Kaposi's disease revealing an immune restoration syndrome with the aim of contributing to a better management. The patient was 38 years old and HIV1 positive, severely immunocompromised with a TCD4 lymphocyte count of 138 cells/mm3. He was admitted to the YO University Hospital for fever associated with a progressive deterioration of the general condition. On admission, he showed signs of anemic cardiomyopathy (functional systolic murmur + edema of the lower limbs + severe anemia at 4.7g/dl) and signs of functional renal failure (creatinine=182 micromol/l). Under treatment, the evolution was favorable and he was discharged from the hospital on antiretroviral treatment (ARV). Three months after the start of ARV treatment, the follow-up assessment noted an increase in TCD4 lymphocytes to 300 cells/mm3 and the skin examination revealed Kaposi's lesions on the thigh. With specific treatment, the evolution was favorable. Conclusion: Early detection and management of HIV infection can prevent some serious manifestations of immune restoration syndrome, such as Kaposi's disease.

La Maladie de Kaposi sur co-infection VIH/Hépatite virale B associée à une épidermodysplasie verruciforme de Lutz-Lewandowski chez un enfant à Thiès (Sénégal)

La Maladie de Kaposi sur co-infection VIH/Hépatite virale B associée à une épidermodysplasie verruciforme de Lutz-Lewandowski chez un enfant à Thiès (Sénégal)

Single Nucleotide Polymorphism Analysis in HIV and Kaposi's Sarcoma Disease by Microarray Technique.

Emergence of Kaposi's Sarcoma in the cases other than HIV, following the use of immunosuppressant drugs, demonstrates that it is related to weak immunity. The fact that this malignancy does not occur in every HIV-positive patient suggests that genetic predisposition may also be effective. Replacement of one of the base pairs of adenine, guanine, cytosine, and thymine that constitute the DNA sequence in the human genome with another base pair can affect susceptibility to disease, response to treatment, and immunity. The purpose of this study is to analyze the Single Nucleotide Polymorphism that could predispose to Kaposi's sarcoma of an HIV-infected patient and to identify which nucleotides such SNPs correspond to, using the microarray technology. The blood samples of individuals, one of whom was diagnosed with Kaposi's Sarcoma HIV (+) visiting the outpatient clinic of infectious diseases polyclinic of Harran University Research and Practice Hospital and of a healthy individual with no Kaposi's Sarcoma, were used in the study. Following the DNA isolation of the blood samples taken from the respective individuals, a SNP analysis was conducted on the microarray device. 204,000 SNPs obtained were scanned later on in the databases in an attempt to identify the SNPs related to Kaposi's Sarcoma. In the 204,000 SNP screenings, we scrutinized the SNPs that differ in the case of Kaposi's Sarcoma [KS (+) and HIV (+)] on the basis of Control [KS(-) and HIV(-)] and HIV+ [KS(-)], and two SNPs of the ENDRA gene, three SNPs of the ADRA1A gene, six SNPs of the STIM1 gene, four SNPs of the EFNB2 gene, and one SNP of the CD209 gene were found to be different. However, when it comes to all SNPs (all the 204.000 SNPs) screened in terms of allele, it was observed that the AA and BB alleles were lower in the patient with Kaposi's Sarcoma [KS (+) and HIV (+)] compared to other groups and AB alleles were found to be higher than others in the patient with Kaposi's sarcoma [KS] (+) and HIV (+)]. In the microarray study we have conducted, 204,000 SNPs were screened for Control (HIV-) HIV (+) and HIV (+) patient with Kaposi's Sarcoma. It was found that 32,362 of those SNPs had different alleles in the Kaposi's Sarcoma [KS + HIV (+)] patient, while they had the same ones in the control [KS (-) and HIV (-)] and HIV + [KS (-)] group. 16 of the 32,362 SNPs took place among the genes related to Kaposi's Sarcoma. In the cases of Kaposi's Sarcoma with suspected diagnosis, it can be used as a beneficial laboratory test.

P32 - Kaposi disease in HIV patients: about 30 cases

P32 - Kaposi disease in HIV patients: about 30 cases

Pigmentations de la muqueuse buccale

Buccal mucosa color is explained by hemoglobin in the vessels and melanin in the epithelium. Abnormal presence of melanin pigments (hypermelaninosis, hypermelanocytosis), hematic pigments (hemoglobin, hemosiderin, iron) but also some exogenous circonstancies explain pigmented lesions (figure 1). These lesions could be localized (single lesions), multifocal (multiple lesions) or diffused. In case of a localized pigmentation with melanic appearance, melanoma must be systematically eliminated with a biopsy. In the case of a more diffused lesion, systemic disease must be evoked. A drug etiology is also possible. A blood pigment excess could be a vascular malformation (flat lesions) or a tumoral process (nodular or swollen lesions). In both cases, Kaposi's disease should be systematically eliminated. Pigmentations near dental restorations (amalgams, prosthetic crowns) could be explained by an exogenous factor but a biopsy should be performed in case of a doubt with melanoma.

Contribution of Dermatopathology in the Diagnosis of Cutaneous Diseases in Côte d’Ivoire

Introduction: Dermatopathology is a fundamental complementary examination for the diagnosis of certain skin conditions when the clinic is hesitant. We therefore initiated this work in order to determine the contribution of dermatopathology in the diagnostic management of certain dermatoses at the Treichville University Hospital Centre of Abidjan. Material and methods: This is a cross-sectional descriptive study with data collection from medical records in the dermatology-venereology and pathological anatomy departments of the Treichville University Hospital Centre. Results: We included and analyzed 184 patients with a sex ratio of 1.2. 46.2% of lesions were generalized with 2% mucosal localization. Erythematosquamous lesions (24.45%) and papules (22.82%) were the most biopsied lesions. The single biopsy sample accounted for 71.2% of the cases and the lesion size ranged from 0.5 cm to 10 cm. Biopsy parts of the lesion alone accounted for 65.2% versus 34.8% for those straddling healthy skin and lesion. Histological diagnosis was established in 91.3%. Kaposi disease accounted for 14.9% of cases followed by psoriasis 11.3%. In the case of three diagnostic hypotheses, the concordance was 84.8%. It was 76.6% for two hypotheses mentioned and 52.3% for a single hypothesis. Conclusion: This work shows that in more than half of the cases, the clinical hypotheses and the histological diagnosis match. It suggests however to continue the training of dermatologists to improve the skin biopsies and invites to initiate clinicopathological confrontations to better refine the diagnoses.

External ear nodule revealing a disseminated Kaposi disease

Kaposi disease (KD) is an angiogenetic tumor process, characterized by its various clinical aspects. Its pathogenesis is multifactorial and it was attributed to HHV-8 infection. We report an original case of disseminated KD revealed by solitary lesion of external ear in a patient treated by corticosteroids for bullous pemphigoid.

Sarcoma idiopático múltiple hemorrágico y pigmentado o enfermedad de Kaposi

El presente trabajo tiene por objeto publicar el primer caso de Enfermedad de Kaposi estudiado en Lima. Esta enfermedad, por su poca frecuencia en nuestro medio, es de difícil diagnóstico. El presente caso fué diagnosticado gracias a la colaboración del Instituto de Anatomía Patológica del Profesor P. Weiss.

Comparison of Kaposi disease outlines in patients with and without HIV infection in two tertiary care hospitals in Bucharest, Romania

Methods A retrospective study on KD was performed in two academic centers, tertiary-care hospitals with national addressability in Romania. Two groups were comparatively studied: HIV-infected patients diagnosed in the National Institute for Infectious Diseases “Prof.Dr. Matei Bals” (HIV-positive group), and non-HIV patients diagnosed in the first Clinic of Dermatology, Colentina Clinical Hospital (HIV-negative group). The statistical analysis was performed using IBM SPSS Statistics v.22 (Chicago, USA).

Treatment of severe or progressive Kaposi's sarcoma in HIV-infected adults.

Background Kaposi's sarcoma remains the most common cancer in Sub-Saharan Africa and the second most common cancer in HIV-infected patients worldwide. Since the introduction of highly active antiretroviral therapy (HAART), there has been a decline in its incidence.However, Kaposi's sarcoma continues to be diagnosed in HIV-infected patients.Objectives To assess the added advantage of chemotherapy plus HAART compared to HAART alone; and the advantages of different chemotherapy regimens in HAART and HAART naive HIV infected adults with severe or progressive Kaposi's sarcoma.Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and , GATEWAY, the WHO Clinical Trials Registry Platform and the US National Institutes of Health's ClinicalTrials.gov for ongoing trials and the Aegis archive of HIV/AIDS for conference abstracts. An updated search was conducted in July 2014.Selection criteria Randomised trials and observational studies evaluating the effects of any chemotherapeutic regimen in combination with HAART compared to HAART alone, chemotherapy versus HAART, and comparisons between different chemotherapy regimens.Data collection and analysis Two review authors assessed the studies independently and extracted outcome data.We used the risk ratio (RR) with a 95% confidence interval (CI) as the measure of effect.We did not conduct meta-analysis as none of the included trials assessed identical chemotherapy regimens.Main results We included six randomised trials and three observational studies involving 792 HIV-infected adults with severe Kaposi's sarcoma.Seven studies included patients with a mix of mild to moderate (T0) and severe (T1) Kaposi's sarcoma. However, this review was restricted to the subset of participants with severe Kaposi's sarcoma disease.Studies comparing HAART plus chemotherapy to HAART alone showed the following: one trial comparing HAART plus doxorubicin,bleomycin and vincristine (ABV) to HAART alone showed a significant reduction in disease progression in the HAART plus ABV group (RR 0.10; 95% CI 0.01 to 0.75, 100 participants); there was no statistically significant reduction in mortality and no difference in adverse events. A cohort study comparing liposomal anthracyclines plus HAART to HAART alone showed a non-statistically significant reduction in Kaposi's sarcoma immune reconstitution inflammatory syndrome in patients that received HAART plus liposomal anthracyclines (RR 0.49; 95% CI 0.16 to 1.55, 129 participants).Studies comparing HAART plus chemotherapy to HAART plus a different chemotherapy regimen showed the following: one trial involving 49 participants and comparing paclitaxel versus pegylated liposomal doxorubicin in patients on HAART showed no difference in disease progression. Another trial involving 46 patients and comparing pegylated liposomal doxorubicin versus liposomal daunorubicin showed no participants with progressive Kaposi's sarcoma disease in either group.Studies comparing different chemotherapy regimens in patients from the pre-HAART era showed the following: in the single RCT comparing liposomal daunorubicin to ABV, there was no significant difference with the use of liposomal daunorubicin compared to ABV in disease progression (RR 0.78; 95% CI 0.34 to 1.82, 227 participants) and overall response rate. Another trial involving 178 participants and comparing oral etoposide versus ABV demonstrated no difference in mortality in either group. A non-randomised trial comparing bleomycin alone to ABV demonstrated a higher median survival time in the ABV group; there was also a non-statistically significant reduction in adverse events and disease progression in the ABV group (RR 11; 95% CI 0.67 to 179.29, 24 participants).An additional non-randomised study showed a non-statistically significant overall mortality benefit from liposomal doxorubicin as compared to conservative management consisting of either bleomycin plus vinblastine, vincristine or single-agent antiretroviral therapy alone (RR 0.93; 95% CI 0.75 to 1.15, 29 participants). The overall quality of evidence can be described as moderate quality. The quality of evidence was downgraded due to the small size of many of the included studies and small number of events.Authors' conclusions The findings from this review suggest that HAART plus chemotherapy may be beneficial in reducing disease progression compared to HAART alone in patients with severe or progressive Kaposi's sarcoma. For patients on HAART, when choosing from different chemotherapy regimens, there was no observed difference between liposomal doxorubicin, liposomal daunorubicin and paclitaxel.

Kaposi Disease in Hospitalization: Reflet of Accessibility to Haart in African Countries? Case of Dermatology Department of the University Hospital of Treichville (Abidjan-Rci)

Background: Several studies have showed that the prognosis and the incidence of Kaposi disease had been improved in many countries where HAART was accessible and provided. In Cote d’Ivoire, an improvement of ART accessibility has occurred since 2006, but, few studies have been conducted for measuring potential changes in the epidemiology and the prognosis of the Kaposi disease. The dermatology department of the Teaching Hospital of Treichville, as a reference center for this disease could reflect the changes of interest. This study was first aiming at describing the clinical, therapeutic and progressive aspects of Kaposi disease in HIV-positive patients admitted to the service, then measuring the impact of the improved HAART accessibility. Material and methods: It was a retrospective, describtive and cross-sectionnal study, based on HIV-positive patients medical records from those hospitalized for Kaposi Disease from 1995 to 2010, in the dermatology department of the teaching hospital of Treichville. Results: 96 Medical records from patients were included, which frequency was 6.4 cases/year in hospitalization. The sex-ratio was 1.97 and the mean age was 40, 2 years. The skin lesions were ulcerative and budding in 36.2% of cases; mucous lesions were found in 14.2% and visceral lesions were found in 51% of cases.83 patients were under chemotherapy (86.4%) and 32 were under HAART (33.3%). 5 were not treated for Kaposi disease. The global mortality rate was 39.6%. The frequency of hospital patients decreased from 6.4 cases /year to 1.5 cases /year by 2009.The visceral lesions were frequents (51%) from 1995 to 2009 afterward they were absents. The chemotherapy was the first choice treatment. Interferon was used in 1995 and in 1996 and was abandoned because of the high cost. 20 out of 32 patients were under HAART by 2006. From 1995 to 2008, almost half the patients were dying (40.8%), but, since 2009, no death related to Kaposi disease was observed. Though the global mortality rate was 39.6%, it was almost twice higher among patients without ART (46.9%) as compared to those under HAART (25%). The improvement of the HAART accessibility which occurred in 2006, had impacted the hospitalization frequency, the disease progressive course; clinical and treatment aspects and the mortality rate of Kaposi disease after 3 years.

Maladie de Kaposi : un effet secondaire inhabituel des dermocorticoïdes

Kaposi's sarcoma is an angiogenic tumour associated with HHV8 infection. There are several clinical forms, including those related to acquired immunosuppression. We report a case of nodular lesions in Kaposi's disease that appeared during treatment of bullous pemphigoid with topical corticosteroids. A 74-year-old female patient presented bullous pemphigoid lesions on all four limbs that were treated with clobetasol cream, a topical corticosteroid. After 2 months of treatment, the patient noted the appearance of several asymptomatic purple, erythematous, papulonodular lesions of elastic consistency on her right thigh and both legs. The histological examination revealed Kaposi's disease with positive immunolabelling for HHV8 in the tumour cells. HIV serology was negative. The lesions disappeared 4 months after cessation of corticosteroid therapy and the patient was still in remission one year later. Authentic "Mediterranean" cutaneous Kaposi's disease was apparently revealed in this patient during treatment with extremely potent topical corticosteroids, before regressing completely on discontinuation of the medication. We discuss the various mechanisms that could have contributed to this side-effect of dermal corticosteroids, whose sustained application over a wide area caused HHV8 antigen reactivation.

Association of Kaposi's disease-immunoglobulin monoclonal: a new case

Kaposi disease, a tumor virus-induced, is a cutaneomucosis disease, generated by the virus infection HHV 8 of the gamma-Herpesviridae family. This virus is involved in several lymphoid pathologies. Its role in the plasma cell proliferation genesis during monoclonal gammopathy is discussed, and results are contradictory. The occurrence of Kaposi disease during multiple myeloma was described in the literature. Through this observation, we report the first case associated with monoclonal gammopathy, evolved for 3 years by HIV negative patient, and we discuss the involvement of HHV8 virus in the development of monoclonal immunoglobulin.