SummaryIn women with pre-existing immune thrombocytopenic purpura (ITP), the effect of pregnancy on the course of the disease is poorly known. We performed a dual-centre retrospective cohort study of 118 pregnancies in 82 women with primary ITP. In early pregnancy, the platelet count was <100 9 10 9 /l in 35Á6% of pregnancies. During pregnancy the median platelet count nadir was 66 9 10 9 /l (25th-75th percentile: 42-117), with platelet count <30 9 10 9 /l for 26 pregnancies (22%). In 49% of pregnancies, a significant decrease of the platelet count required treatment at least transiently in preparation for delivery. At the time of delivery, the median platelet count was 110 9 10 9 /l (77-155). Compared to before pregnancy, at 3 months post-partum, only 11% of pregnancies [95% confidence interval (95% CI): 6Á8-20Á2] showed disease worsening. Previous splenectomy was the only factor significantly associated with ITP worsening after pregnancy (53Á9% vs. 10Á3%, P < 0Á001). For 8Á3% of the pregnancies (95% CI: 3Á8-15Á1), neonatal thrombocytopenia required treatment, especially in case of previous maternal splenectomy (adjusted odds ratio 16Á7, 95% CI: 2Á61-106). The overall risk of exacerbation of ITP and severe thrombocytopenia during pregnancy is acceptable.
Introduction
Kaposi’s sarcoma (KS) is an angioproliferative disorder first described in 1872 by Moritz Kaposi. Four main clinical presentations of KS have been described: classic, endemic, iatrogenic and epidemic. KS involvement of the lymph nodes is extremely uncommon in the classical variant form, especially if it precedes the skin manifestations. We describe the case of an elderly HIV-negative patient presenting with lymphadenopathy who was found to have KS.
Case Report
A 67-year-old patient was admitted for exploration of polyadenopathies in the context of a general decline in health. Physical examination revealed an erythematosus left lower limb rash associated with angiomatous nodules and multiple lymphadenopathies. The diagnosis of erysipelas in the left leg was retained and the patient was treated with good evolution of the rash but persistence of the angiomatous nodules and the polyadenopathies. Skin and lymph node biopsies led to a diagnosis of KS. The patient is proposed for polychemotherapy.
Conclusion
KS must be suspected in lymphadenopathies despite the absence of typical cutaneous signs of the disease and in immunocompetent patients.
LEARNING POINTS
Involvement of the lymph nodes is extremely uncommon in the classical variant form of Kaposi’s sarcoma (KS).
Human herpes virus-8 is an important cofactor in all forms of KS.
Pathology and immunohistochemistry are key to diagnosing KS.
KS must be suspected in lymphadenopathies without typical cutaneous signs of the disease and in immunocompetent patients.
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