A 61-year-old male with poorly controlled HIV/AIDS was diagnosed with pulmonary Kaposi sarcoma via transbronchial biopsy despite the absence of typical mucocutaneous lesions.
Case Report (n=1)
Pulmonary Kaposi sarcoma can present without mucocutaneous lesions in advanced HIV/AIDS patients, and transbronchial biopsy can provide a definitive diagnosis despite its risks.
Abstract Introduction Kaposi sarcoma (KS), an angioproliferative neoplasm, is linked to human herpesvirus 8 (HHV-8) and frequently associated with HIV. The widespread adoption of antiretroviral therapy (ART) has significantly reduced its incidence. While KS typically manifests with mucocutaneous lesions that can become systemic, pulmonary Kaposi sarcoma (PKS) as an initial presentation without these lesions is exceptionally uncommon. This report details a case of AIDS-related PKS, diagnosed through transbronchial biopsy, in a patient who was not adherent to ART. Case Presentation A 61-year-old male with poorly controlled HIV/AIDS presented with a positive cryptococcal antigen. He had prior hospitalization for pneumonia and sepsis, where a chest CT showed bilateral nodular opacities. A lung biopsy suggested adenocarcinoma, but was inconclusive. Stains were negative for fungi, mycobacteria, bacterial, and viral organisms. Further evaluation revealed a CD4 count of 2 cells/mm³ and high viral load. He received fluconazole for cryptococcus. Subsequent imaging showed worsening nodular opacities, predominantly on the left. Bronchoscopy with transbronchial biopsy ultimately confirmed Kaposi sarcoma with positive HHV-8 staining. Discussion Primary Kaposi Sarcoma (PKS) predominantly affects the tracheobronchial tree, pulmonary parenchyma, and pleura. Diagnosing PKS is particularly challenging when mucocutaneous involvement is absent. Characteristically, laboratory tests reveal immunosuppression (CD4 150) and a high HIV viral load. Radiographic imaging of PKS often shows peribronchovascular reticular opacities or irregular pulmonary nodules, typically in the lower lobes. Endobronchial lesions, if present, appear as violaceous or bright red macules or papules. Histopathology confirms the diagnosis with HHV-8 positivity via PCR or IHC, revealing spindle cell proliferation with angiogenesis and inflammation. Despite the high risk of bleeding and limited diagnostic yield (26-60%), a transbronchial biopsy was performed in this case due to clinical uncertainty and strong suspicion. This case highlights the importance of considering PKS in immunocompromised patients with atypical pulmonary findings, even without mucocutaneous lesions. Conclusion Pulmonary Kaposi sarcoma (PKS) can be challenging to diagnose in advanced HIV/AIDS patients without mucocutaneous involvement. It is important to maintain a high suspicion for PKS in immunocompromised individuals with unexplained pulmonary infiltrates, even with initial biopsy results suggesting other causes. Transbronchial biopsy, despite risks and limited sensitivity, can offer a definitive diagnosis in select cases, enabling timely treatment. This abstract is funded by: None
Esguerra et al. (Fri,) conducted a case report in Pulmonary Kaposi Sarcoma (n=1). Transbronchial biopsy was evaluated. A 61-year-old male with poorly controlled HIV/AIDS was diagnosed with pulmonary Kaposi sarcoma via transbronchial biopsy despite the absence of typical mucocutaneous lesions.