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Clinical Summary

Kaposi sarcoma (KS) is a low-grade vascular tumor associated with human herpesvirus 8 (HHV-8). Since the introduction of highly active antiretroviral therapy (HAART), the incidence of KS in HIV-infected persons has significantly declined. Skin involvement is characteristic, but extracutaneous spread of KS is common, particularly to the oral cavity, gastrointestinal (GI) tract, and respiratory tract. The skin lesions appear most often on the lower extremities, face (especially the nose), oral mucosa, and genitalia. Most commonly, the lesions are papular, ranging in size from several millimeters to centimeters in diameter. Less commonly, the lesions may be plaque-like, especially on the soles of the feet, or exophytic and fungating with breakdown of overlying skin. Papular lesions may resemble lesions associated with bacillary angiomatosis or herpesvirus infections.

Pulmonary involvement can occur in AIDS-related KS. Affected persons may present with shortness of breath, fever, cough, hemoptysis, or chest pain or as an asymptomatic finding on chest x-ray. Diagnosis can be confirmed via bronchoscopy.

Management and Disposition

All HIV-infected patients with KS should receive ART, which is generally effective in treating most cutaneous lesions. Systemic chemotherapy and immunomodulator therapy (interleukin-12, angiogenesis inhibitors) are reserved for more extensive disease including patients with visceral involvement.

Pearls

  1. HIV patients who present with new papular lesions should be referred for dermatologic evaluation and biopsy.

  2. A careful examination of the skin and oral cavity is appropriate in HIV-infected patients presenting with GI or respiratory complaints.

  3. KS herpesvirus inflammatory cytokine syndrome (known as KICS) should be suspected when a patient with HIV and KS presents with fever, respiratory or GI symptoms, or a sepsis-like picture.

FIGURE 20.8

Kaposi Sarcoma. A single violaceous plaque is seen on the face of an HIV-positive patient. (Photo contributor: George W. Turiansky, MD.)

FIGURE 20.9

Cutaneous Kaposi Sarcoma. Characteristic violaceous KS lesions on the leg of this Caucasian patient with HIV. (Photo contributors: Seth W. Wright, MD, and Universidad Peruana Cayetano Heredia, Lima, Peru.)

FIGURE 20.10

Kaposi Sarcoma. Multiple black KS lesions, as typically seen in darker skinned patients. (Photo contributor: Seth W. Wright, MD.)

FIGURE 20.11

Kaposi Sarcoma. Multiple raised KS lesions are seen on the leg of this patient with advanced HIV. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 20.12

Kaposi Sarcoma. Multiple KS lesions surrounding the nipple of this patient with advanced HIV. (Photo contributor: Seth W. Wright, MD.)

FIGURE 20.13

Oral Kaposi Sarcoma—Tongue. Raised palpable erythematous KS on the ...

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