Donor‐derived human herpes virus 8‐related Kaposi's sarcoma in renal allograft ureter

Abstract

We present a case of human herpes virus 8 (HHV8)-associated Kaposi sarcoma (KS) occurring in a renal allograft ureter from a male donor. The female patient presented with a rising creatinine due to ureteric obstruction, and subsequent histological examination of the excised tumor revealed a KS. The tumor tested positive for HHV8 antigen and, using in situ hybridization to identify X and Y chromosomes, we were able to demonstrate that the tumor was of male origin. In the absence of any other KS lesions, this suggested that the tumor arose due to reactivation of latent HHV8 in the donor tissue, permitted by the recipient's immunosuppression. The patient was managed by a gradual reduction in immunosuppression and there has been no subsequent recurrence of the tumor. KS in renal transplantation is discussed in detail including the possible utility of pre-transplant HHV8 screening.

Kaposi Sarcoma of the Ureter After Liver Transplant: Case Report and Literature Review

“…1 Two cases of Kaposi sarcoma originating from the transplant ureter after a kidney transplant have been reported. 2,3 However, to the best of our knowledge, none has been reported in the native ureter.…”

Rozsiany mięsak Kaposiego skóry u pacjentki przyjmującej tryptolid/trypdiolid z powodu reumatoidalnego zapalenia stawów

“…Triptolide has immunosuppressant activity [28]. Decreasing CD4 cells [29], triptolide could contribute to development of KS by reactivation of latent HHV8, permitted by triptolide-induced immunosuppression [5]. On the other hand, triptolide is an anti-cancer compound [15,30] and KS is not mentioned among the adverse effects of triptolide, ethyl acetate extracts or polyglycosides of the Chinese herbal remedy Tripterygium wilfordii Hook F [4,6–9].…”

“…Triptolide and tripdiolide, compounds originally purified from Tripterygium wilfordii Hook F [1] and used for centuries in traditional Chinese medicine to treat RA [2–4], could contribute to development of KS by reactivation of latent human herpes virus 8 (HHV8), permitted by triptolide-induced immunosuppression [5]. To date, KS has not been mentioned among adverse effects of triptolide, ethyl acetate extracts or polyglycosides of the Chinese herbal remedy Tripterygium wilfordii Hook F [4,6–9], although dermal reactions including different kinds of rush with the tendency to develop erosion and scarring were described with incidence of 55.5% during 12 weeks of treatment with polyglycosides of Tripterygium wilfordii Hook F [9].…”

Human Herpesvirus 6, 7 and 8 in Solid Organ Transplantation

“…KS presents in transplant patients as red or violaceous lesions of the skin or oral mucosa, but may also involve the lymph nodes or visceral organs, including the transplanted allograft . Presenting symptoms of PEL are dependent on the location (primarily the pleural, peritoneal or pericardial spaces) and size of the effusion.…”