Abstract Introduction Kaposi sarcoma (KS) is an angioproliferative cancer caused by human herpesvirus 8 (HHV-8). KS can be associated with acquired immunodeficiency syndrome (AIDS) and is referred to as epidemic KS. KS often presents with cutaneous lesions but can also have visceral involvement, including the pulmonary system, resulting in increased morbidity and mortality. Case description We present a case of a 32-year-old incarcerated male with no known medical history who presented with 5 months of non-bloody diarrhea, weight loss, anasarca, purple nodules over his gingiva, and violaceous skin lesions. His workup revealed a new diagnosis of HIV (CD4 count 315 cells/μL) complicated by CMV viremia, syphilitic uveitis, and rectal chlamydia. Computed tomography (CT) of the chest showed bilateral mediastinal lymphadenopathy, diffuse bilateral peribronchovascular pulmonary nodules, interlobular septal thickening, and bilateral pleural effusions. Punch biopsy of a skin lesion confirmed KS. He underwent a bronchoscopy, which demonstrated scattered violaceous endobronchial lesions throughout his tracheobronchial tree (Fig. 1). Bronchoalveolar lavage revealed 67% lymphocytes and HHV-8 PCR positivity, and endobronchial biopsies confirmed KS. A subsequent left-sided thoracentesis yielded straw-colored fluid, and the pleural fluid analysis was consistent with a transudative effusion with 78% lymphocytes. Cytology showed atypical cells positive for HHV-8. He was treated with antiretroviral therapy (ART), IV ganciclovir, IV penicillin G, and oral doxycycline. Referral to outpatient oncology was placed for consideration of additional chemotherapy for metastatic KS following treatment of his active infections. Discussion Though pulmonary involvement in KS is less common with increased availability of ART, it remains associated with higher morbidity and mortality. Despite a national decrease in the incidence of HIV and KS, incarcerated individuals remain a vulnerable population with high disease prevalence. Common radiographic findings of pulmonary KS include interlobular septal thickening, bilateral and symmetric peribronchovascular nodules, mediastinal adenopathies, and pleural effusions, all of which were seen in our patient. These findings in a patient with AIDS are highly suggestive of KS. On bronchoscopy, the identification of characteristic endobronchial lesions is sufficient for a presumptive diagnosis of KS, but it can be further confirmed with biopsy. Metastasis beyond skin and lymph nodes results in higher staging of KS, with National Comprehensive Cancer Network guidelines recommending the addition of chemotherapy to ART; liposomal anthracyclines are first-line therapy. Given the complexity in management, utilization of a multidisciplinary treatment team including pulmonology, infectious disease, and oncology is imperative in the diagnosis and treatment of metastatic epidemic KS. This abstract is funded by: None
Huynh et al. (Fri,) studied this question.