Aggressive conjunctival Kaposi sarcoma as the initial manifestation of acquired immunodeficiency syndrome

Abstract

Purpose To report a case of Kaposi sarcoma in a patient with previously undiagnosed Human Immunodeficiency Virus (HIV) infection. Observations A 23-year-old male patient presented to the eye clinic with complaints of redness of his left eye for the past month. The patient had been seen one day prior to presentation in the emergency department for a neck mass and pneumonia. Exam was notable for a left hemorrhagic, nodular, bulbar conjunctival mass, a right hemorrhagic conjunctival lesion, and violaceous facial skin lesions. Due to suspicion for conjunctival Kaposi sarcoma, HIV and Acquired Immune Deficiency Syndrome (AIDS) serologies were obtained which returned positive. Biopsies of the ocular mass and axillary lymph nodes confirmed Kaposi sarcoma. The patient was started on anti-retroviral therapy and Doxorubicin. The left conjunctival mass initially progressed to cover most of his cornea but eventually regressed by 6 months. Conclusions and Importance Ocular involvement of Kaposi sarcoma as the initial manifestation of HIV/AIDS is rare with only a few reported cases. Since the advent of highly active antiretroviral therapy, conjunctival or adnexal Kaposi sarcoma is not commonly encountered by healthcare providers. Concern for Kaposi sarcoma of the conjunctiva in this patient led to the evaluation for HIV/AIDS. It is vital for all healthcare providers to have Kaposi sarcoma in the differential diagnosis of a hemorrhagic conjunctival or adnexal mass and be familiar with its association with HIV/AIDS. If suspected, appropriate counseling and testing should be performed.

Kaposi's Sarcoma and Lymphoedema in a HIV Sero-positive Patient: A Case Report and Literature Review

“…Similarly, in this reported case showed oral lesions associated with a skin nodular lesion that arose after the emergence of oral lesions. In the reported case, the presence of extensive oral lesions raised suspicions of KS associated with the HIV infection [5], [19], [29], [31], [32].…”

“…Small and single KS lesions can be surgically excised [19] and local recurrence is rare after complete excision of the primary lesion. However, in the event of relapse, it occurs six months to two years after the procedure [19], [29].…”

“…Current evidence suggests that KS often goes into remission with HAART, and HIV-infected patients on antiretroviral therapy are inflicted with a less aggressive form of KS than those who are not on antiretroviral therapy at the time of diagnosis [19,29] .…”

“…HIV-KS is common in African countries where there are widespread HIV infections, an endemic HHV8 infection, and where there is poor availability of antiretroviral medication [12]- [14]. Oral Kaposi's sarcoma (OKS) commonly occurring tumour with lesions that may be single or multifocal, non-pigmented to brownish-red or violaceous in colour [15]- [17], on the hard and soft palate, gingiva, and dorsal tongue [6], [17]- [19]. OKS may be associated with pain, bleeding, and functional interferences [17]- [19].…”

“…Oral Kaposi's sarcoma (OKS) commonly occurring tumour with lesions that may be single or multifocal, non-pigmented to brownish-red or violaceous in colour [15]- [17], on the hard and soft palate, gingiva, and dorsal tongue [6], [17]- [19]. OKS may be associated with pain, bleeding, and functional interferences [17]- [19]. The initial lesions may manifest initially as ecchymotic or erythematous patches [20]- [22] which develop into nodular, that progress to papular, and ultimately become confluent forming large exophytic forms which could invade bone and create tooth mobility and morbidity [14], [23], [24].…”