Kaposi’s Sarcoma during Immunosuppressive Therapy for Atopic Dermatitis

Abstract

We describe an HIV-negative homosexual man who developed Kaposi’s sarcoma (KS). He had CD4 lymphocytopenia during azathioprine and topical corticosteroid therapy for atopic dermatitits (AD). KS was observed after only 2 months of immunosuppressive therapy. No regression was observed despite discontinuation of immunosuppressive therapy and normalization of the CD4+ cell count. This patient appears to be the first case of KS associated with AD. Moreover, as our patient had been sexually inactive for 15 years, this case raises the questions about the latency and about the sexual transmission of a novel herpes-like virus (KHSHV) recently detected in all forms of KS.

Steroids are a risk factor for Kaposi's sarcoma-immune reconstitution inflammatory syndrome and mortality in HIV infection

“…Our study has shown four-fold odds of Kaposi's sarcoma-related mortality in individuals receiving glucocorticoids, after controlling for possible confounding factors. Glucocorticoid therapy has also been clinically associated with development of Kaposi's sarcoma in non-HIV-related diseases such as transplant recipients [ 14 , 15 ]; rheumatic disorders [ 16 , 17 ]; asthma [ 18 ]; lung cancer [ 19 ]; dermatologic diseases [ 20 , 21 ]; atopic dermatitis [ 22 ]; ulcerative colitis [ 23 ]; glomerulonephritis [ 24 , 25 ] and many other clinical conditions of iatrogenic immunosuppression. In most cases, withdrawal of immunosuppressive therapies leads to Kaposi's sarcoma remission, but not in the case of HIV-infected individuals [ 7 ].…”

Azathioprine in dermatology: The past, the present, and the future

“…241 Common skin problems include alopecia, verrucae, zoster, increased skin color, and malignant neoplasms. 240 Kaposi sarcoma, [242][243][244][245] dermatomycoses, 246,247 cytomegalovirus infection, 248 and scabies [249][250][251][252] have also been reported with azathioprine use.…”

A Case of Kaposi's Sarcoma Following Treatment of Membranoproliferative Glomerulonephritis and a Review of the Literature

“…[7] It has been suggested that immunosuppressives such as glucocorticoids and cyclosporine do not activate the lytic cycle of HHV-8 or modify the cell survival, thus promoting cancer progression by a direct cellular effect. [16] There are KS cases reported following treatments with corticosteroid therapy of various rheumatologic, [4] dermatologic, [17][18][19] hematologic (ITP), [20] and gastrointestinal [21,22] disorders. Nephrologists are also familiar with KS because of immunosuppressive treatment following renal transplantation, and they encounter it in HIVinfected patients as well, though less frequently.…”