The Diagnostic Challenge of Pulmonary Kaposi???s Sarcoma With Pulmonary Tuberculosis in a Renal Transplant Recipient: A Casereport

Abstract

We report a case of a 39-year-old, HIV-negative, post renal transplant patient who developed mucocutaneous Kaposi's sarcoma with lung parenchymal involvement and concurrently culture proven pulmonary tuberculosis. To the best of our knowledge, this is the first case report of this combination, which presented with cavitating lung nodules and responded well to withdrawal of immunosuppressive drugs beside antituberculous treatment.

Kaposi sarcoma: A continuing conundrum

“…[196][197][198][199][200][201][202][203][204][205][206] The frequency of visceral lesions in classic American KS has been noted to be well below the almost uniform systemic involvement seen in homosexuals and others with AIDS-related KS. 207 In one series of patients with AIDS-associated KS, the most common visceral involvement sites were the lungs (37%), gastrointestinal tract (50%), and lymph nodes (50%).…”

“…54,248 KS itself may produce clinical problems including edema from impaired lymphatic draining, difficulty ambulating, friable cutaneous nodules, secondary localized skin infection, upper airway obstruction and bilateral chylothoraces, 358 and gut disorders ranging from obstruction to appendicitis. [192][193][194][195][196][197][198][199][200][201][202][203][204][205][206][208][209][210][211][212][213][214][215]359 There is also an increased incidence of diabetes mellitus among classic KS patients. 67,112 PROGNOSIS Clinical classification of KS may be the best prognosticator, comparing localized nodular disease, locally aggressive disease, and generalized KS.…”

Granulomas in acquired immunodeficiency syndrome‐associated cutaneous Kaposi sarcoma: evidence for a role for Mycobacterium tuberculosis

“…Cutaneous TB and KS are characterized by individual histomorphological heterogeneity 19,25 . The tuberculous foci in the two reported renal transplant patients with co‐lesional KS and TB showed nodal NNGI and pulmonary NGI 23,24 . More recently, postmortem nodal AIDS‐KS with large areas of necrosis containing numerous ‘tubercle bacilli’ on ‘special’ stain in a 40‐year‐old HIV‐infected patient has been documented 26 .…”

“…The HIV/AIDS pandemic has also heralded an explosion of AIDS‐KS in parts of Africa, 22 with an approximately 20‐fold increased incidence being documented in Uganda and Zimbabwe. Notwithstanding the vast clinicopathological spectrum of cutaneous AIDS‐KS and cutaneous TB, the high prevalence of TB, HIV/AIDS and KS, and the co‐existence of TB in 20% of AIDS/KS patients, to date, co‐lesional cutaneous AIDS‐KS and TB, a rarely reported extracutaneous transplant‐associated phenomenon in HIV negative patients, 22–24 is surprisingly unreported. Whether such co‐lesional disease is a real rarity or an underreporting or underrecognition phenomenon is speculative.…”

Is Classic Kaposi’s Sarcoma Endemic in Peru?: Report of a Case in an Indigenous Patient

“…Some of the cases reported in HIV-negative individuals included patients with splenic non-Hodgkin lymphoma, Hodgkin's disease, post-renal transplants, and orificial tuberculosis. [16][17][18][19][20] The presence of multisystemic tuberculosis and classic KS in our patient is unusual; the conclusion is that immunosuppression caused by severe tuberculosis could be involved in KS onset and progression. The diagnosis obtained through conventional staining with hematoxilin and eosin was confirmed using antibodies to the ORF73 HHV-8-encoded protein (called the latency-associated nuclear antigen), which have proven to react exclusively with the spindle-shaped cells of KS, revealing a nuclear dot-like staining pattern.…”