A case of mistaken identity: classic Kaposi sarcoma misdiagnosed as a diabetic foot ulcer in an atypical patient

Abstract

Background The presentation of Kaposi sarcoma is divided into four known clinical subtypes. In this case report we describe classic Kaposi sarcoma in an African-American heterosexual, diabetic, seronegative human immunodeficiency virus male. Classic Kaposi sarcoma is rare in this patient demographic and can be easily misdiagnosed. Case presentation The patient presented with a lesion between the fourth and fifth digits of his right foot which was initially diagnosed as a diabetic foot ulcer. Despite local wound care, the lesion did not resolve. A shave biopsy was performed and histopathology findings were consistent with classic Kaposi sarcoma. Conclusions The patient tolerated local radiotherapy well and had complete resolution of his pedal lesion. There have been emerging associations between diabetes and Kaposi sarcoma. As such, clinicians should have a low threshold when considering the biopsy of suspicious pedal lesions in patients with diabetes. The utilization of appropriate biopsy technique may lead to the diagnosis of classic KS tumors in populations outside of the current four widely accepted clinical subtypes.

An unusual case of pyogenic granuloma-like Kaposi sarcoma

“…Four clinical subtypes of KS are recognized in the U.S.: classic, endemic, iatrogenic, and epidemic. Classic KS tends to occur on the hands and feet of elderly men of Eastern European and Mediterranean origin [4]. Endemic KS predominantly affects men of African origin, aged 25 to 40 [2].…”

“…Endemic KS predominantly affects men of African origin, aged 25 to 40 [2]. Iatrogenic KS occurs in patients undergoing immunosuppressive treatment, such as those who have undergone chemotherapy or organ transplantation [4]. Epidemic KS is seen in patients with HIV/AIDS [4].…”

Tumor Lysis Syndrome: Introduction of a Cutaneous Variant and a New Classification System

“…The key feature is necrosis and ulceration of the skin tumors in the absence of therapy. In addition, albeit rare to date, cases suggestive of this diagnosis have been observed in patients with untreated solid tumors (such as melanoma, breast cancer, and Kaposi sarcoma) [7,[27][28][29][30][31][32][33][34][35][36][37][38][39].…”

“…However, it remains unclear if some of these cases were accompanied by rapid tumor death, a key feature of cutaneous tumor lysis syndrome [7,[27][28][29][30][31][32][33][34][35][36][37][38][39]. Solid tumors: In addition to patients with Kaposi sarcoma, characteristics possibly compatible with solid tumor-associated spontaneous (idiopathic) cutaneous tumor lysis syndrome have also been reported in patients with other solid tumors (Table 4) [7,[35][36][37][38][39]. For example, a 79-year-old man with metastatic melanoma in whom the phenomenon was referred to as giant centrifugal and necrotizing cutaneous metastases of melanoma [35].…”

Clinical characteristics of lower extremity ulcers

“…11 This is especially important as the prevalence of malignant wounds is increasing and, at first sight, they can appear to be ordinary wounds. 16,17 After these examinations, the wound should be assessed using the TIME model. 18 All wounds should be examined with a probe and a positive probe-to-bone result is a marker of osteomyelitis and probable diabetic foot ulcer infection.…”