Resolution of diffuse skin and systemic Kaposi's sarcoma in a renal transplant recipient after introduction of everolimus: a case report

Abstract

We present a case report of a patient with diffuse skin and systemic Kaposi's sarcoma (KS), 1 year after renal transplantation. A concomitant Pyrenochaeta romeroi granuloma of the right hallux was diagnosed and illustrated an important immunodysfunction in our patient. Four months after reduction in immunosuppression and switch to everolimus, a total regression of the KS was observed. Reduction in the immunosuppression and treatment with terbinafine cleared the P. romeroi infection, while lowering immunosuppression and changing the type of immunosuppressive therapy were important steps in the successful management of the KS. In recent years, evidence of the antitumor effects of everolimus is increasing: total regression of KS in combination with renal function preservation in renal graft recipients is possible with mammalian target of rapamycin (mTOR) inhibitor-based regimens. In addition, with increasing numbers of human immunodeficiency virus-positive transplant recipients, mTOR inhibitors may play a more crucial role in the management of KS.

An Update on Kaposi’s Sarcoma: Epidemiology, Pathogenesis and Treatment

“…However, certain immunosuppressants may be less likely to put patients at risk for iatrogenic KS. For example, sirolimus or everolimus (mTOR inhibitors) appear to inhibit the occurrence and/or progression of KS in transplant recipients while preventing organ rejection [19, 20]. These drugs may reduce the effect of vascular endothelial growth factor (VEGF) which is believed to play a pivotal role in the pathogenesis of KS [20].…”

Everolimus and Malignancy after Solid Organ Transplantation: A Clinical Update

“…Reduction of immunosuppressive intensity is the first step in management, but the Kidney Disease Improving Global Outcomes (KDIGO) recommendations suggest that treatment with an mTOR inhibitor also be started [53]. This recommendation was largely based on evidence using sirolimus [54], but several case reports have described successful outcomes for Kaposi's sarcoma in kidney transplant patients following conversion to everolimus [48, 52, 55, 56] (Table 1). These cases, while limited, are consistent with the available evidence relating to management of Kaposi's sarcoma in nontransplanted individuals by everolimus alone [58–60].…”

Phaeohyphomycosis caused by Medicopsis romeroi in solid organ transplant recipients: Report of two cases and comprehensive review of the literature

“…We retrieved 12 cases of M romeroi infection in SOT recipients reported in 10 different articles . Two cases reported in two large series of fungal infections, respectively, were not included in the present review due to a lack of information.…”

“…Histology was consistent with a fungal infection in seven of eight cases, showing the presence of hyphae in the biopsy. M romeroi was identified using PCR techniques in all cases reporting this information (8 of 10 cases) …”