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Kaposi Sarcoma (KS) is an angioproliferative tumor associated with human herpes virus 8 (HHV-8).  Often known as one of the acquired immunodeficiency syndrome (AIDS)-defining skin diseases, pulmonary involvement in KS has only been discussed in a handful of case reports, rarely in a non-HIV patient. Herein we report the case of a 77 year-old- male who presented with a 6-week history of progressive dyspnea on exertion accompanied by productive cough of yellow sputum and intermittent hemoptysis. His past medical history was significant for Non-Hodgkin’s Follicular B-Cell Lymphoma (NHL). Patient also had biopsy-confirmed cutaneous KS. His physical exam was notable for a 2cm firm, non-tender, mobile right submandibular lymph node.  Lungs were clear to auscultation. He had multiple violet non-tender skin lesions localized to the lower extremities. CT scan of the chest showed numerous nodular opacities and small pleural effusions in both lungs. A thoracenthesis was performed, showing sero-sanguineous exudative effusions. Histopathology failed to demonstrate malignant cells or lymphoma. A subsequent bronchoscopy revealed diffusely hyperemic, swollen mucosa of the lower airways with mucopurulent secretions. Bronchoalveolar lavage PCR for HHV-8 showed 5800 DNA copies/mL.  It was believed that his pulmonary symptoms were likely due to disseminated KS.  This case illustrates the potential for significant lung injury from KS. It also demonstrates the use of PCR for HHV-8 to diagnose KS in a bronchoalveolar lavage sample in a case when bronchoscopic biopsy was not safe. Furthermore, this case is unique in that the patient did not match the typical KS subgroups as HIV infection and other immune disorders were ruled out. Recognition of this syndrome is critical to the institution of appropriate therapy. As such, this case should be of interest to a broad readership across internal medicine including the specialties of Pulmonology and Critical Care.

Objective: Natural disasters, domestic terrorism and other forms of catastrophe, though rare, pose a significant public health challenge when they do occur.  Hospital personnel must have the appropriate training to identify, treat, and possibly even oversee local disaster preparedness initiatives. Insufficient resources have been placed on the education received by healthcare providers in tertiary medical institutions. We intended to assess the current state of knowledge and interest in disaster preparedness among different tiers of hospital staff and training levels in order to identify potential barriers and areas for further training. Design: A cross-sectional online survey was given to hospital attending physicians, subspecialty fellows, residents, nurses, physician assistants, and their respective students. The survey questions were disseminated throughout the Society of Critical Care Medicine (SCCM) Members and the North Shore Long Island Jewish (NSLIJ) hospital system via e-mail newsletters. Main results: A total of 572 individuals participated between October 2013 and May 2014. 85% of respondents expected to be dealing with a disaster during their career. 61.5% of respondents noted they would not feel comfortable leading and directing a local disaster management initiative.  Yet 51.9% of respondents treated victims of natural disasters, 56.5% of transportation disasters and 34.8% of a structural collapse.  When asked about level of formal disaster management training: 27.5% noted that no training was provided and 33% noted that they received 12 hours of training and only a quarter had more than 48 hours of formal training. 86.6% of respondents noted an interest in participating in a disaster management training workshop. Conclusions: Many of our respondents had low level of disaster management training, did not feel comfortable leading a disaster initiative, however many have had to take care of victims of disasters.  Based on our findings, hospital professionals feel under prepared for disaster management, and disaster preparedness should be considered an integral part of medical training.

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