Case Report: Pulmonary Kaposi Sarcoma in a non-HIV patient

Abstract

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.

Usefulness of Endobronchial Ultrasound in Patients with Human Immunodeficiency Virus Infection and Mediastinal Lymphadenopathy

“…This was also observed in our population with a diagnosis of malignancy: Kaposi sarcoma was the most frequent (50%). There are reports of cases of Kaposi sarcoma with lung involvement in non-HIV patients, mainly those with an immunocompromising condition, such as hematologic cancers, renal insufficiency and melanomas [15,16] . In our series, pulmonary adenocarcinoma occurred at the same frequency as lymphoma.…”

Kaposi Sarcoma in an Human Immunodeficiency Virus (HIV)-Seronegative Mediterranean Female: Report of a Rare Case

“…Dermatic lymphatic involvement [ 4 ] can also appear. Other than skin lesions and lymph nodes, Kaposi syndrome can present extracutaneous spread to the oral cavity and gastrointestinal tract, or present as lung injuries, even in patients with no HIV infection or other immune disorders [ 5 ].…”

Pulmonary Kaposi Sarcoma: An Uncommon Cause of Respiratory Failure in the Era of Highly Active Antiretroviral Therapy—Case Report and Review of the Literature

“…Occasionally this classic finding might be absent and the only bronchoscopic evidence might be hyperemia, edema of the lower airways, or complete occlusion of the endobronchial tree [19, 20]. Biopsy may be challenging due to the highly vascular nature of the malignancy with associated increased risk of bleeding and in such cases PCR for HHV-8 can be done on the bronchoalveolar lavage sample [19]. Detection of HHV-8 can be as high as 80% in BAL from HIV positive patients with endobronchial KS [21].…”