COVID-19 Vaccination in Patients with Classic Kaposi’s Sarcoma

Abstract

The novel coronavirus disease 2019 (COVID-19) has represented an overwhelming challenge for worldwide health systems. Patients with cancer are considered at higher risk for severe COVID-19 and increased mortality in case of infection. Although data on the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in patients with cancer are limited, there is enough evidence supporting anti-infective vaccination in general in patients with active cancer, or with history of previous malignancy. Subjects with classic Kaposi’s sarcoma (KS) represent a small subset of cancer patients, which should be considered at heightened risk for infections due to several factors including age, and impaired immune function status. Several cases of human herpesviruses reactivation among critically ill COVID-19 patients have been described. Moreover, in case of severe infection and treatment with immunomodulating agents, patients with CKS are exposed at significant risk of viral reactivation and disease progression. Considering the baseline clinical risk factors of patients with CKS, and the complex interplay of the two viral agents, SARS-CoV-2 vaccination should be strongly recommended among patients with KS. KS represents an interesting field to study the interactions among chronic viral infections, SARS-CoV-2 and the host’s immune system. Prospective observational studies are needed to provide more insights on vaccine activity and safety among patients with cancer, optimal vaccine schedules, potential interactions with antineoplastic therapies, and other comorbidities including chronic viral infections.

Unilateral conjunctival Classic Kaposi Sarcoma following a COVID 19 booster

“…There are no other case reports of KS in the literature as a result of vaccination which is still recommended in patients with KS. 14 We hypothesize that COVID19 vaccination and the local immunosuppression caused by topical loteprednol and cyclosporin were the major co-factors needed to induce the localized conjunctival KS in this case.…”

“…It deserves repeating that no other case reports of KS in the literature as a result of COVID19 vaccination exist and that vaccination is still recommended in patients, even those with a history of KS. 14 For the ophthalmologist who discovers conjunctival Kaposi's sarcoma, it is important to coordinate care with a team consisting of a medical/ophthalmic oncologist (and/or HIV-specialist), and radiation oncologist. This report helps expand the current understanding of potential cofactors needed in addition to HHV8 infection for the development of KS.…”

Cutaneous and subcutaneous Kaposi's sarcoma lesions treated with electrochemotherapy

“…Most studies using ECT to achieve local control of skin lesions only include classic KS patients. 1,2,15 Classic KS skin lesions usually develop in elderly men, 2,16 it is believed that the absence of systemic adverse effects of ECT and the low impact on immune system functions can be an advantage in this population subset. 15 Despite the classic subtype being the most frequent variant in our geographic area, our institution also receives patients from African countries.…”