A 30-year-old male patient, diagnosed with HIV in 2019, had been out of care for one year, with viral load of 15,100 copies/mm³ and CD4 of 169 cells/mm³. He was admitted to the emergency department with a history of gonorrhea treatment three months prior, followed by penile lesions and pruritic, scaly rashes on palms and soles. He was diagnosed with indeterminate syphilis and treated with three doses of benzathine penicillin. After the second dose, he developed submandibular, supraclavicular, and inguinal lymphadenopathy, with pain, redness, and edema in the testicular and penile region. He received doxycycline for 15 days with no improvement. He also had a two-week hospitalization for dengue and COVID-19. He lost 10 kg in three months. He had restarted antiretroviral therapy on his own one month prior. On admission, he presented violaceous lesions in the gingiva and oropharynx, about 1.0 × 1.0 cm, and hardened, painful lymph nodes in cervical, submandibular, and inguinal regions. Laboratory and imaging tests were performed, and hematology consultation suggested Kaposi sarcoma. Biopsies of inguinal lymph nodes and oral lesions confirmed the diagnosis. The patient improved clinically and was discharged to start chemotherapy. At 15-day follow-up, oral lesions regressed spontaneously, lymphadenopathy improved, and he had weight gain. On follow-up laboratory evaluation, there was a substantial improvement in the immunologic profile after approximately 50 days of consistent antiretroviral therapy. The CD4 count increased from 169 cells/mm³ to 260 cells/mm³, and the viral load decreased from 15,100 copies/mL to 49 copies/mL. At subsequent follow-up, lesions had completely regressed. In agreement with oncology, Kaposi sarcoma was attributed to Immune Reconstitution Inflammatory Syndrome, and conservative management continued. The patient remained asymptomatic, with full remission of lesions, improvement of lymphadenopathy, and weight gain.
Souza et al. (2026) studied this question.