Contrasting Lymphatic Filariasis with Kaposi Sarcoma in a Known HIV Disease Patient: A Clinical and Histopathological Presentation and Implication to Care

Abstract

Lymphatic filariasis is a systemic disease arising from infestation with filarial worms. The species that commonly infest the lymphatic vessels include Wuchereria bancrofti and Brugia malayi. The larval stages of the worms are transmitted by biting mosquitoes or flies. Wuchereria bancrofti is transmitted by night biting anopheline mosquitoes. The infection is common in tropical Africa. The adult worms infiltrate the lymphatics and produce large numbers of microfilaria into the circulation. The species B. malayi is inoculated by Mansonia or Anopheles mosquitoes and is known to cause less severe disease. Infection with W. bancrofti may present diversely from subclinical infection to overt manifestation such as elephantiasis. Acute infection may present with febrile illness, pain or tenderness in the area of the inflammed lymphatics. The chronic phase is usually characterized by presence of lymphadenopathy in lower limbs, retroperitoneal tissues, lymphedema, hydrocele and elephantiasis. The clinical presentation of lymphatic filariasis can mimic that of Kaposi Sarcoma, a malignancy common in advanced HIV disease and may present a diagnostic dilemma especially in the absence of histopathologic findings. We report a case of a 73 year old known HIV disease patient presenting with chronic indurating leg swelling. Histopathology report revealed papillomatus and hyperkeratotic skin lesions with no evidence of malignancy and no presence of microfilaria on a blood smear.