Vertebral Lesions from AIDS-Related Kaposi's Sarcoma
Stefano Di Bella2011, Current HIV Research
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Abstract
Background: Kaposi's sarcoma is commonly described in HIV/AIDS patients but usually manifests as overt skin lesions or visceral involvement. Bone involvement, particularly vertebral, is uncommon, especially when there is no adjacent cutaneous lesion but a small number of cases have been reported. Unlike many other diseases associated with HIV, Kaposi's sarcoma can occur despite a normal CD4 count. Case Presentation: A 44 year-old HIV positive Nigerian man presented with a 20 day history of severe, worsening lumbar back pain, nearly three years after an earlier diagnosis of a single cutaneous lesion consistent with Kaposi's sarcoma, for which he received chemo-radiotherapy. Despite varying previous compliance with his anti-retroviral therapy, he was thought to be taking his medications at time of presentation and his CD4 count was 408 cells/mm 3. No other organ involvement was found but a pathological fracture was seen on magnetic resonance imaging affecting L1 vertebra. A CTguided needle aspiration biopsy was performed and a histological diagnosis subsequently confirmed Kaposi's sarcoma. The patient was treated with further courses of radiotherapy but had little clinical improvement. Indeed, a follow-up MRI four months later showed new involvement of a further four vertebrae, fortunately in the absence of progressive focal neurology. Conclusion: Vertebral Kaposi's sarcoma is a rare diagnosis but can be accurately diagnosed with CT or MRI imaging in conjunction with a histological diagnosis. An immunosuppressed patient presenting with bone pain should be thoroughly investigated for Kaposi's sarcoma as modern chemotherapeutic agents alongside anti-retroviral therapy may delay or prevent further devastating complications such as spinal cord compression.
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Jornal Brasileiro de Patologia e Medicina Laboratorial, 2012
Primeira submissão em 19/04/11 Última submissão em 28/09/11 Aceito para publicação em 19/10/11 Publicado em 20/02/12 Solitary Kaposi's sarcoma in retromolar region of an HIV positive patient: case report Sarcoma de Kaposi em região retromolar de um paciente HIV positivo: relato de caso Maiara de Moraes 1 ; Marcelo Gadelha Vasconcelos 2 ; Rodrigo Gadelha Vasconcelos 3 ; Rafael Cabral 4 ; Igor Lira Gomes 5 ; Lélia Maria Guedes de Queiroz 6 1. Mestra em Patologia Oral; doutoranda do programa de Pós-graduação em Patologia Oral da Universidade Federal do Rio Grande do Norte (UFRN). 2. Doutor em Patologia Oral pela UFRN. 3. Mestre em Odontologia; doutorando do Programa de Pós-graduação em Patologia Oral da UFRN. 4. Cirurgião-dentista; especialista em Cirurgia e Traumatologia. 5. Cirurgião-dentista; especialista em Cirurgia e Traumatologia. 6. Doutora; professora da disciplina de Patologia Oral da UFRN. Kaposi's sarcoma is a malignant neoplasm of vascular origin. It occurs mainly among immune deficient individuals, thus it is the most common neoplasm among HIV-positive patients. Its pathogenesis is complex and has not been fully clarified. This case arouses particular interest due to its anatomic location in the retromolar region of a 39-year-old male HIV-positive patient, who presented low white blood cell count and was not undergoing antiretroviral therapy. The emergence of this lesion may be associated with highly active antiretroviral therapy (HAART) discontinuation and leukopenia. Hence, the reestablishment of therapy allows a suitable therapeutic approach and contributes to prognosis and survival rates.
Kaposi Sarcoma Associated with Human Immunodeficiency Virus Infection
International Journal of Dermatology, 1991
In the present study, 11 patients with epidemic Kaposi sarcoma wete evaluated; 55% wete In stage IV and 45% in stage 11; in addition, 75% had systemic symptoms, 89% had low total and T-lymphocyte counts, and all of them had not only low T-helper lymphocyte counts but also Thelpet/T-supptessor ratios. The majotity of patients (89%) had tow proliferative responses with phytohemaggiutinin (PHA). Nine patients were treated with: alpha-2 interferon (five patients), zidovudine (two patients), doxorubicin and zidovudine (one patient), and radiotherapy (one patient). There were only five patients with stable disease, three treated with alpha-2 interferon, one with doxorubicin, and one with doxorubicin plus azidothymidine. Two patients (one with doxorubicin and one with doxorubicin plus zidovudine) needed lithium to increase leukocyte and platelet counts. In May 1989, 73% of patients were dead (median survival 8 ±2 months). It is concluded that: (1) it is important to select the patients who have the best chance to improve with treatment; (2) the response with atpha-2 interferon or monochemotherapy is low and there is no change in overall survival; (3) a low helper cell count, low Thelper/ T-suppressor ratio, and low proliferative response with mitogens are features of poor prognosis; (4) toxicity with treatment was acceptable; and (5) lithium increased neutrophil and platelet counts. Kaposi sarcoma (KS) was first described as "idiopathic multiple pigmented sarcomas of the skin" by Moritz Kaposi in 1872. It is a rare tumor except in some African countries (Uganda, Zaire) where KS represents 9% of all registered tumors. Classical KS-affected individuals are older than 60 years, with Eastern European or Italian extraction. The lesions are localized in the legs and are treated principally with local radiotherapy or monocbemotherapy. Epidemic Kaposi sarcoma (EKS) began to be described in young homosexual men witb severe depression of cellular immunity in the spring of 1981. The cutaneous lesions are disseminated, affecting the head, neck.
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