Transplant-associated penile Kaposi sarcoma managed with single agent paclitaxel chemotherapy: a case report

Abstract

Background Kaposi’s sarcoma is an uncommon complication in renal transplant patients, and typically presents with cutaneous lesions on the lower extremities. Penile involvement has been reported only rarely. Management of cutaneous-limited disease is primarily reduction of immunosuppression and conversion to an mTOR-inhibitor, whereas the treatment of disseminated disease in transplant patients is more variable. Case presentation A 75-year-old male, originally from Somalia, received a deceased-donor kidney transplant for diabetic and hypertensive nephropathy. Seven months post-transplant he presented with lower limb lesions, oedema and bilateral deep vein thromboses. He then developed a fast-growing painful lesion on his penile shaft. A biopsy of this lesion confirmed KS, and a PET scan demonstrated disseminated disease in the lower extremities, penis and thoracic lymph nodes. His tacrolimus was converted to sirolimus, and his other immunosuppression was reduced. He was treated with single agent paclitaxel chemotherapy in view of his rapidly progressing, widespread disease. The penile lesion completely resolved, and the lower extremity lesions regressed significantly. His kidney allograft function remained stable throughout treatment. Conclusion This case illustrates a rare presentation of an uncommon post-transplant complication and highlights the need for a high index of suspicion of KS in transplant patients presenting with atypical cutaneous lesions. It serves to demonstrate that the use of single agent paclitaxel chemotherapy, switch to an mTORi and reduction in immunosuppression where possible produces excellent short-term outcomes, adding to the body of evidence for this management strategy in disseminated Kaposi’s sarcoma.

Transplant-associated Kaposi’s sarcoma in a kidney allograft: a case report

“…The most common site for KS lesions is the skin. Even when visceral lesions are present, they usually affect the lymph nodes, lungs, and gastrointestinal tract rather than allografts [ 11 ]. In this case, we encountered not only lymph node and lymphoproliferative lesions, but also KS invading the allograft itself [ 3 ].…”

Case Report: Metagenomic Next-Generation Sequencing Can Contribute to the Diagnosis and Treatment of Disseminated Visceral Kaposi Sarcoma Following Allogeneic Haematopoietic Stem Cell Transplantation

“…HHV-8 infection is quite common after HSCT. However, PT-KS, particularly its disseminated visceral form, is a very rare complication, and its relationship with HHV-8 has been reported infrequently ( 27 , 28 ). In this study, we reported a patient who developed disseminated visceral KS following HSCT, which predicted an inferior prognosis.…”

Human herpesvirus 8 and Kaposi sarcoma: how should we screen and manage the transplant recipient?

“…Due to low prevalence of Kaposi sarcoma after HSCT and no documented & ]. Use of single agent paclitaxel chemotherapy together with switch to m-TORi has been successfully used in disseminated Kaposi sarcoma [43].…”

“…Patients whose lesions do no not regress despite reduction in immunosuppression may require surgical excision, radiation therapy or cytotoxic chemotherapy [24 ▪ ,29 ▪ ]. Use of single agent paclitaxel chemotherapy together with switch to m-TORi has been successfully used in disseminated Kaposi sarcoma [43].…”