Kaposi's sarcoma associated with immunosuppression for bullous pemphigoid

Abstract

Kaposi's sarcoma may occur in transplant recipients on immunosuppressive regimens, but is not well recognized in association with treatment for dermatological disease. We report two cases where multifocal Kaposi's sarcoma developed following iatrogenic immunosuppression with prednisolone and azathioprine for bullous pemphigoid. Both patients were HIV negative and, in one case, lesions regressed both clinically and histologically when immunosuppressive therapy was withdrawn.

Infection and Infection Prevention in Patients Treated with Immunosuppressive Medications for Autoimmune Bullous Disorders

“…Multifocal Kaposi sarcoma (HHV-8) has occurred in patients treated for bullous pemphigoid. 19 Patients taking systemic immunosuppressive medications are also at increased risk for reactivation of hepatitis B virus, which may lead to irreversible liver damage. 20 Fungal Localized Superficial cutaneous fungal infections, such as dermatophytosis and candidiasis, may also complicate the course of patients being treated for autoimmune bullous dermatoses (Fig.…”

Azathioprine in dermatology: The past, the present, and the future

“…241 Common skin problems include alopecia, verrucae, zoster, increased skin color, and malignant neoplasms. 240 Kaposi sarcoma, [242][243][244][245] dermatomycoses, 246,247 cytomegalovirus infection, 248 and scabies [249][250][251][252] have also been reported with azathioprine use.…”

Serological and immunohistochemical detection of human herpesvirus 8 in Kaposi's sarcoma after immunosuppressive therapy for bullous pemphigoid.

“…We report a patient who did not have KS before immunosuppressive treatment for bullous pemphigoid (BP) and who later developed fulminant KS after 4 months of oral prednisolone therapy for BP. Up to the present, seven cases of KS associated with immunosuppression for BP have been reported 6–11 . In two of the seven cases, HHV‐8 DNA was identified in the total DNA extracted from KS tissue specimens.…”

“…These findings are characteristic of the nodular type of KS. The dose of oral prednisolone was gradually reduced to 30 mg daily, and spontaneous regression of KS was expected 10,11 . Instead, however, BP recurred and KS spread rapidly over almost the entire body.…”