Kaposi's Sarcoma

Purplish skin lesions appeared on the back and trunk of a 34-year-old homosexual man with HIV-1 disease. The spots had been growing larger over the past several weeks.

The patient's medical history was significant for oral candidiasis and Pneumocystis carinii pneumonia (PCP). His T-cell count was 47 cells/mL. He was not taking any antiretroviral medication and was noncompliant with PCP prophylactic therapy. A low-grade fever was noted.

In addition to the back and trunk eruptions, the patient had mild violaceous lesions under the tongue. None of the lesions were painful. There was no pruritus and no history of allergies. A biopsy of material from a lesion revealed prominent spindle cell proliferation surrounded by ex-travasated erythrocytes and macrophages. Endothelial cells also were seen. These findings confirmed the diagnosis of Kaposi's sarcoma of the skin and underside of the tongue.

Gopi Rana-Mukkavilli, MD of New York writes that Kaposi's sarcoma usually presents as a cutaneous, nonblanching, red macule and often becomes nodular, necrotic, and confluent, developing into large violaceous plaques. Usual therapy is subcutaneous injections of interferon.

Kaposi's sarcoma is the most common angiogenic tumor in patients with HIV-1 disease. It is estimated that its occurrence is 20,000 times greater among HIV-infected persons than in the general population. Kaposi's sarcoma occurs most often in HIV-positive, homosexual men and is associated with significant morbidity and mortality, especially if the lungs and gastrointestinal tract are involved.

These tumors also may arise on the conjunctiva and cardiac structures. Severe mucocutaneous and visceral lesions are treated with systemic cytotoxic agents such as paclitaxel and liposomal anthracyclines.

Kaposi's sarcoma does occur in transplant recipients and other non-HIV–infected immunocompromised patients. Recently, human herpesvirus type 8 has been implicated as a possible cause of Kaposi's sarcoma.

This patient was given interferon and zidovudine; the lesions improved significantly. He has returned to work and continues therapy with protease inhibitors and antiretroviral agents.