Gastrointestinal Kaposi's sarcoma associated to AIDS. Case report

In this paper, we describe a particular clinical case of gastrointestinal Kaposi's sarcoma associated with acquired immunodeficiency syndrome in a 51-year-old female patient who survived 6 years without anti-retroviral treatment after the diagnosis of HIV infection. The patient was admitted to our hospital with fever, skin lesions in both upper limbs and thighs (one day of evolution) and dry cough (about a month of evolution). She was admitted to the General Internal Medicine Service for control, diagnosis and treatment. An upper digestive bleeding was detected there. Once referred to our Gastroenterology Service, an appropriate selection of tests (anamnesis, gastric video endoscopy, histology) was carried out. In the upper gastric video endoscopy, several epithelial lesions were observed and a presumptive diagnosis of Kaposi's sarcoma was obtained. The diagnosis was finally confirmed by chain polymerase reaction (PCR) amplifcation of HHV8 DNA. This finding highlights the contribution of the molecular biology laboratory that allowed in this case the first molecular identification in our institution of the causative agent of Kaposi's syndrome with gastrointestinal manifestations.     

AIDS-associated Kaposi's sarcoma in female patients

Kaposi's sarcoma (KS) is very unusual in Caucasian women with AIDS. We conducted a retrospective survey of 12 female AIDS patients with KS, including 11 Caucasian women. HIV infection was thought to have been acquired after sexual contact, intravenous drug use (nine cases) or blood transfusion (three cases). In these patients KS was often the first manifestation of AIDS and showed an aggressive course. The disease was associated with a severe immunodeficiency (CD4 T lymphocyte count less than 100 x 10(6)/l in 50% of cases) and a poor prognosis. In four patients, lesions first developed on areas of sexual contact, supporting the hypothesis that KS is a sexually transmitted disease.     

Aggressive Kaposi's sarcoma and campylobacter bacteremia in a female with transfusion associated AIDS

The vast majority of patients with Kaposi's sarcoma (KS) of the epidemic, endemic or sporadic variety are men. Although 35 percent of men with AIDS will develop KS, only three percent of women will develop this malignancy. To date, a single case report of transfusion associated KS in an HIV-infected female has been described in the medical literature. We report a second case. A 54-year-old HIV-infected female without other identifiable risk factors for AIDS developed disseminated KS six years after a blood transfusion. Her illness was marked by rapidly proliferating tumors not responsive to a single course of chemotherapy. Another unusual aspect of this case is that, in conjunction with weight loss and diarrhea, Campylobactercinaedi was recovered from her blood. This enteric pathogen has previously been described exclusively in homosexual men. Autopsy studies showed KS tumors involving all major visceral organs. This case report demonstrates that in HIV-infected females KS may follow an aggressive course similar to that seen occasionally in male KS patients with profound immunosuppression.     

Microcirculatory disturbances in AIDS patients--a first report

The aim of this study is to explore the vascular perturbations associated with AIDS infections as a means of developing strategies to help in the treatment of these patients. Closed-circuit television microscopic observation of the microcirculation in the nail fold was carried out on 11 AIDS patients and 11 healthy European adults. A striking pattern of severe microvascular disturbances was demonstrated in these patients: (i) a suppression of the spontaneous, rhythmic adjustments of capillary blood perfusion, and (ii) damage to the endothelium of the capillary wall. These findings suggest a substantial involvement of the microcirculation in the pathogenetic development of the AIDS syndrome, as well as a close relationship between microvascular perfusion and the immune condition of the organism. The data indicate that the treatment of the AIDS patient should be directed not only toward the inhibition or killing of the virus, but also toward the improvement of microcirculatory perfusion.     

Intrathoracic Kaposi's sarcoma in women with AIDS

STUDY OBJECTIVE: To describe the radiographic features of intrathoracic Kaposi's sarcoma in women with AIDS. Subjects and methods: From 1987 to 1998, we identified seven women with biopsy-proven (n = 4) or autopsy-proven (n = 3) pulmonary Kaposi's sarcoma. Charts were reviewed for HIV risk factors, cutaneous and/or oropharyngeal Kaposi's sarcoma, CD4 cell count, and differential diagnosis of pulmonary disease prior to the diagnosis of pulmonary Kaposi's sarcoma. Chest radiographs (n = 6), chest CT scans (n = 3), and reports of unavailable chest radiograph (n = 1) closest to the time of diagnosis of pulmonary Kaposi's sarcoma were reviewed for the following: nodular and peribronchovascular opacities; thickened interlobular septa; pleural effusions; lymphadenopathy; and radiographic stage. RESULTS: Mean patient age was 33 years (range, 27 to 42 years). HIV risk factors were IV drug use (n = 2), heterosexual contact (n = 3), and both (n = 2). All patients had prior opportunistic infections. The median CD4 cell count was 18 /microL (mean, 63/microL; range, 5 to 210/microL). Cutaneous Kaposi's sarcoma was diagnosed prior to pulmonary Kaposi's sarcoma in four patients, subsequently in two patients, and not identified in one patient. Oropharyngeal Kaposi's sarcoma was diagnosed prior to pulmonary Kaposi's sarcoma in three patients. Only infection was considered in the differential diagnosis of the patients' pulmonary disease in five patients. One patient presented with acute hemoptysis and died, and one patient recently received a diagnosis of pulmonary Karposi's sarcoma at another hospital. Chest radiographic findings were the following: nodular opacities in five of seven patients (71%); peribronchovascular opacities in six of seven patients (86%); thickened interlobular septa in two of seven patients (29%); pleural effusion in three of seven patients (43%); and lymphadenopathy in two of seven patients (29%). Five of seven patients (71%) were determined to be in radiographic stage 3, one patient in stage 1, and one patient in stage 2. CT demonstrated additional lymphadenopathy in three of three patients, thickened interlobular septa in two of three patients, and pleural effusion in one of three patients, but it did not change the staging of disease in any patient. CONCLUSION: Pulmonary Kaposi's sarcoma can cause diffuse lung disease in women with AIDS. The disease is usually mistaken clinically for pulmonary infection.     

Diagnosis of pulmonary Kaposi's sarcoma in AIDS patients

Pulmonary Kaposi's sarcoma (KS) is one of the many manifestations of AIDS. There are no specific tests for its early diagnosis. Because its symptoms may be similar to tuberculosis, it may be diagnosed incorrectly and treated as such. Consequently, by the time of the correct diagnosis, valuable time will have been lost for effective medical care that could positively impact prognosis. The discussion in this case study is focused on pulmonary KS with an interest in improving premorbid diagnosis that may lead to an earlier recognition and better treatment of the disease.     

AIDS presenting with cutaneous Kaposi's sarcoma and bacillary angiomatosis in the bone marrow mimicking Kaposi's sarcoma

Kaposi's sarcoma (KS) and bacillary angiomatosis (BA) may be histologically similar. A precise diagnosis is required because of the different management of these diseases. KS or BA involving bone marrow is rare in patients with and without acquired immune deficiency syndrome (AIDS). We report the case of a 40-year-old human immunodeficiency virus (HIV)-positive homosexual male who presented with small KS lesions in the skin and BA in the bone marrow that histologically were similar. Laboratory evaluation revealed anemia and thrombocytopenia; CD4 count was 103/mm3, and the viral load was 750,000 HIV-1 mRNA copies per milliliter in plasma. Bartonella henselae, the etiologic agent of BA, was isolated from a blood culture. DNA sequences of human herpesvirus-8 (HHV-8), the putative etiologic agent of KS, were identified by polymerase chain reaction (PCR) in skin and bone marrow specimens, but antibody anti-HHV-8-encoded protein ORF73, localized signals only in the skin-KS lesion. The patient received clarithromycin and cefotetan for the BA, and antiretroviral therapy for the HIV infection. The skin lesions gradually regressed, the HIV-1 mRNA copy number decreased to less than 400 per milliliter and the CD4 lymphocyte count increased to 665/mm3. In conclusion, vascular lesions of BA and KS may be clinically and histologically similar, both may be associated with advanced AIDS, and an accurate diagnosis is required because of their different management.     

Pulmonary and pleural localizations of Kaposi's sarcoma in AIDS

Intrathoracic Kaposi's sarcoma (KS) in AIDS is remarkable for its frequency and severity. It is responsible for 10% of "pneumonias" and almost 50% of pleurisies observed in these patients. The time elapsed between the discovery of the lesion and the patient's death does not exceed a few months on average. The initial manifestations of pulmonary KS are usually discreet and consist of cough and/or dyspnoea in patients with KS of the skin and mucosae. Fever is lacking or moderate. The most suggestive radiological findings are dense, nodular, tumour-like opacities and bilateral linear and/or micronodular opacities around the bronchi and vessels. The diagnosis rests on bronchial fibroscopy which shows red, non friable lesions which, to a trained endoscopist, are very characteristic. When these lesions are absent, thoracotomy may be necessary for diagnostic purposes. Treatment essentially consists of chemotherapy; zidovudine therapy and prophylaxis of pneumocystosis are indicated if the circulating CD 4 cell count falls below 200/mm3. When its symptoms are predominant, pleural KS is typically progressive, with normal or slightly elevated temperature, associated parenchymal lesions that are clearly visible on CT scans and copious, bilateral, blood-stained serous or chylous pleural fluid. When these signs are absent throacoscopy or thoracotomy may be necessary. Future advances in this field will be due not only to improvements in chemotherapy but also to a better understanding of the physiopathology of intrathoracic Kaposi's sarcoma.     

Kaposi's sarcoma and lymphoma of the gut in AIDS

KS and non-Hodgkin's lymphomas frequently involve the gut in patients with AIDS. These neoplasms establish the diagnosis of AIDS in an HIV-positive patient. KS is a spindle-cell tumour derived from lymphatic endothelia which is associated with luminal lesions in at least 40% of patients. Gastrointestinal KS is usually asymptomatic but may rarely bleed or obstruct. Treatment of KS with either interferon-alpha, radiation or chemotherapy can reduce tumour bulk, but does not alter overall survival in AIDS. Non-Hodgkin's lymphomas in AIDS are B cell neoplasms with many genotypic and phenotypic similarities to Burkitt's lymphoma. The tumours are usually highly aggressive, and present in extranodal sites in the majority of cases. Of these extranodal sites, gastrointestinal involvement is most common. Gastrointestinal lymphomas are usually symptomatic and almost always require treatment. Obstruction, perforation and bleeding may occur in patients with luminal involvement, whereas hepatic or biliary disease may lead to jaundice. Several chemotherapeutic regimens for lymphoma have been successfully used to achieve partial remission, although no prolongation of survival has been demonstrated. There appears to be an increased incidence of Hodgkin's disease in patients with AIDS, which is generally of advanced stage. This tumour does not meet the CDC criteria for AIDS as yet. Hepatic and/or splenic involvement in this setting are common.     

Lympho-cutaneous Kaposi's sarcoma in an African pediatric AIDS case

A case of disseminated Kaposi's sarcoma with lymphoid and mucocutaneous involvement in an African infant with acquired immune deficiency syndrome is reported. The child died within 2 months after recognition.     

Prognostically significant classification of immune changes in AIDS with Kaposi's sarcoma

Sixteen immunological parameters were assessed quantitatively for their value in providing an immunologically-based and prognostically significant classification of the immune alteration in 97 patients with AIDS and Kaposi's sarcoma (AIDS-KS). The dimensions of reductions in the T4 (T helper-inducer cells) subpopulation of lymphoid cells in the T4-T8 ratio were found to correlate most closely with prognosis. Most other immunological changes did not relate to clinical course. T4 lymphocyte levels greater than 300/microL and a T4-T8 ratio greater than 0.5 indicated a relatively good prognosis, eg, 85% to 95% survival at 12 months. T4 levels less than 100/microL and/or a T4-T8 ratio less than 0.2 had a very poor prognosis, eg, less than 25% survival at 12 months. Intermediate T4 levels and T4-T8 ratios had intermediate prognosis. These immunological findings were found to have independent prognostic value for survival when compared with disease classifications based on tumor stage (I through IV) or on clinical status A (without) or B (with fever, night sweats, or weight loss). Reduced proliferative capacity, increased OKT10 antigen expression, elevated levels of serum IgA, and immune complexes also correlated with prognosis. Elevated levels of serum IgG, cellular HLA-DR expression, and skin test anergy occurred frequently in AIDS-KS but did not have prognostic significance. Variations in level of total lymphocyte, T8 (T suppressor/cytotoxic) cell, gamma FcR receptor-positive cell number, NK activity, or level of serum IgM were less common in AIDS-KS and did not correlate with prognosis.