Kaposi’s Sarcoma Presenting as Lymphadenopathy in an Immunocompetent Patient

Abstract

Introduction Kaposi’s sarcoma (KS) is an angioproliferative disorder first described in 1872 by Moritz Kaposi. Four main clinical presentations of KS have been described: classic, endemic, iatrogenic and epidemic. KS involvement of the lymph nodes is extremely uncommon in the classical variant form, especially if it precedes the skin manifestations. We describe the case of an elderly HIV-negative patient presenting with lymphadenopathy who was found to have KS. Case Report A 67-year-old patient was admitted for exploration of polyadenopathies in the context of a general decline in health. Physical examination revealed an erythematosus left lower limb rash associated with angiomatous nodules and multiple lymphadenopathies. The diagnosis of erysipelas in the left leg was retained and the patient was treated with good evolution of the rash but persistence of the angiomatous nodules and the polyadenopathies. Skin and lymph node biopsies led to a diagnosis of KS. The patient is proposed for polychemotherapy. Conclusion KS must be suspected in lymphadenopathies despite the absence of typical cutaneous signs of the disease and in immunocompetent patients. LEARNING POINTS Involvement of the lymph nodes is extremely uncommon in the classical variant form of Kaposi’s sarcoma (KS). Human herpes virus-8 is an important cofactor in all forms of KS. Pathology and immunohistochemistry are key to diagnosing KS. KS must be suspected in lymphadenopathies without typical cutaneous signs of the disease and in immunocompetent patients.

Fine-Needle Aspiration of Sarcomas Metastatic to Lymph Nodes: A Cytomorphologic Study over a 10-Year Period

“…The involvement of lymph nodes by Kaposi sarcoma is not an uncommon event, accounting for up to 33% of patients with Kaposi sarcoma [16]. The epidemic and endemic forms are the most common forms to show lymph node involvement, while rare cases have been reported in the other forms [17]. It is unclear if isolated Kaposi sarcoma lesions involving lymph nodes represent a primary lymph node disease or a disseminated disease of an involuted cutaneous or visceral primary.…”

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

“…The other results included 3 patients with HHV-8-related hemophagocytic syndrome (HS), but no evidence of KS, in a 61-year-old Taiwanese immunocompetent man [ 10 ] and two Italians over sixty years old following steroidal treatment for autoimmune hemolytic anemia [ 11 ]. A localized cutaneous KS, started as inguinal lymph node involvement, was reported in a 67-year-old Tunisian hypertensive and diabetic man [ 12 ]. 8 cases of cutaneous and/or mucosal KS in immunocompetent individuals were also reported (a 77-year-old Irish man, 2 men under 50 years old of unknown origin, a 55-year-old Afro-American man, 4 Turkish men of whom 3 over 70 years old and 1 of 27 years old) [ 13 – 16 ].…”