Kaposi Sarcoma in a Patient With AIds: Case Report With Exuberant and Disseminated Cutaneous Presentation

Kaposi sarcoma (KS) is an angioproliferative neoplasm associated with human herpesvirus 8 (HHV-8), which can affect the skin, mucous membranes, lymph nodes, and viscera. Transmission usually occurs through oral secretions, and the mechanism of oncogenesis is not fully understood. Individuals coinfected with HIV have a higher risk of KS, and before the introduction of antiretroviral therapy, up to 30% of such patients developed the disease. This case describes a 33-year-old male patient diagnosed with HIV in 2022, with CD4 of 52, who started but irregularly used ART. In March 2024, he developed a violaceous plaque on the left lower limb, followed by multiple disseminated skin lesions. He progressed with confluent purplish nodules on the left leg and ankle, forming an exophytic tumor mass with satellite nodules and foul-smelling exudate suggestive of secondary infection, associated with lymphedema of the affected limb. He also had a purpuric lesion on the hard palate and reported bloody sputum, fever, and weight loss for 30 days. HIV viral load was 227,000 copies/mL and CD4 was 92. Histopathology suggested KS, and immunohistochemistry was positive for HHV-8 and CD31. CT scans revealed bilateral pulmonary consolidations, multiple lymphadenopathies, and splenomegaly. Bronchial biopsy and upper endoscopy confirmed mucosal involvement of the bronchi and esophagus by KS. According to AIDS Clinical Trials Group (ACTG) and anatomic/clinical classifications, the case represented advanced KS. ART was restarted, and he was referred for oncology care. He received radiotherapy in 2024 and began paclitaxel chemotherapy in October. After one year of ART, viral load was undetectable, CD4 was 162 cells/µL, and there was clinical improvement with regression of skin lesions and partial reduction of the tumor in the lower limb. Recent colonoscopy and endoscopy showed no lesions. Despite declining incidence, KS remains one of the most common neoplasms in people with HIV and often presents aggressively, with disseminated and visceral disease. Exuberant lesions require differential diagnosis with infections and cutaneous neoplasms. Even with atypical presentations, KS should always be considered, with definitive diagnosis relying on histopathology and immunohistochemistry.