Disseminated Kaposi sarcoma following COVID-19 in a 61-year-old Albanian immunocompetent man: a case report and review of the literature

Abstract

Background COVID-19 and its related anti-inflammatory treatment (steroids, immunomodulators) may induce the reactivation of latent bacterial, parasitic, and viral infections. According to our knowledge, no case of disseminated HHV-8-related Kaposi sarcoma (KS) after COVID-19 and its treatment has been described so far. Only one case of cutaneous KS concurrently with COVID-19 has been previously reported. Case presentation We describe a case of disseminated KS in a 61-year-old immunocompetent Albanian man after hospitalization for COVID-19. Methods for literature research We used PubMed as biomedical database for the literature research. We selected keyword combinations including “Kaposi sarcoma,” “HHV-8,” “immunocompetent,” “COVID-19,” “SARS-CoV-2,” and “steroids.” No time or language limitation was set. Titles and abstracts of selected articles were systematically screened. Articles were included in the examination if they were published under free access through the digital library of the University of Brescia (Italy), and provided full text. Articles were excluded if the topic was beyond the aim of our study. Finally, we selected 15 articles. Results We describe a case of KS in COVID-19 patient and postulate that Interleukin-6 (IL-6) activity and steroid-induced immunodeficiency may play a major role in KS emergence. No published case of disseminated KS following COVID-19 in otherwise healthy individuals was found through the systematic literature review, despite the high incidence of COVID-19 in areas with medium–high prevalence of HHV-8 infection. This observation might be explained by the role of individual genetic susceptibility factors. Conclusions SARS-CoV-2 infection and its treatment may lead to reactivation of several latent infections, including HHV-8 and its related clinical syndrome, Kaposi sarcoma.

SARS‐CoV‐2 infection and lytic reactivation of herpesviruses: A potential threat in the postpandemic era?

“…The authors speculated that SARS‐CoV‐2 stimulates a hyper‐inflammatory status which may contribute to KSHV reactivation, replication, and ultimately the recurrence of KS. Similarly, a case of disseminated KS in an immunocompetent patient after hospitalization for COVID‐19 was recently reported 25 . The authors of this study postulated that interleukin‐6 (IL‐6) activity and steroid‐induced immunodeficiency played a major role in KS emergence.…”

“…Similarly, a case of disseminated KS in an immunocompetent patient after hospitalization for COVID‐19 was recently reported. 25 The authors of this study postulated that interleukin‐6 (IL‐6) activity and steroid‐induced immunodeficiency played a major role in KS emergence. Finally, a study of 104 patients in South Africa, where there is a high prevalence of herpesviruses infections, reported that coinfection with KSHV but not EBV might be associated with the severity of clinical outcomes following COVID‐19.…”

Herpes Zoster Ophthalmicus in an Immunocompetent Child With Concurrent COVID-19 Infection: A Case Report and Literature Review

“…Over the past two years of the COVID-19 pandemic, there have been several cases of co-infections and superinfections occurring alongside COVID-19 [ 13 ]. Among patients with COVID-19, various skin manifestations have been reported, including HZ [ 14 ].…”

Epidemiology, clinical profiles, and prognostic value of COVID‐19‐related cutaneous manifestations in African populations: a rapid narrative review

“…However, case studies from other settings have been described, establishing characteristics of cutaneous manifestations in COVID‐19/HIV co‐infected people. Gardini et al 56 . reviewed the literature and described a case report of KS in a COVID‐19/HIV co‐infected patient.…”

“…Gardini et al 56 reviewed the literature and described a case report of KS in a COVID-19/HIV co-infected patient. The researchers hypothesized that KS in COVID-19 was caused by interleukin-6 (IL-6) activity and steroid-induced immunodeficiency, with IL-6 activity and steroid-induced immunodeficiency both playing important roles in the emergence of KS.…”