Kim Caren M. Dumalnos*, Daryl Andaya, Bernard Demot and Jolene Kristine Dumlao
Introduction: AIDS-related Kaposi sarcoma decreased dramatically over the last two decades with the introduction of ART. It has improved the prognosis and outcome of PLHIV, however, delayed initiation lead to higher risk of AIDS defining illness such as Kaposi sarcoma. In the Philippines, the true prevalence of AIDS-related Kaposi sarcoma has not been established. This case is being reported for its rarity in the Philippines and to discuss diagnostic approach and treatment options available for disseminated AIDS-related Kaposi sarcoma in our locality.
Objectives: To discuss a rare case of disseminated AIDS-related Kaposi sarcoma in the advent of ART.
Case summary: A 31-year-old male diagnosed with HIV last 2016 who was not on ART presented at the ER with AIDS-defining signs and symptoms. He was admitted and opportunistic infections were treated accordingly, however there was persistent febrile episodes in which fever of malignancy was considered. The patient had multiple skin nodules and patches characterized as purple and localized over the trunk, bilateral upper and lower extremities. He also presented with multiple cervical and inguinal lymphadenopathies. He underwent skin lesion and excision cervical lymph node biopsy with histopathologic diagnosis consistent with Kaposi sarcoma. Further metastatic work-up were also done such as CT scan of the chest, whole abdomen and EGD-colonosopy with tissue biopsy. The patient was started on antiretroviral 2 weeks prior to discharge and was advised close follow-up at the OPD for chemotherapy planning. On follow-up admission, the lesions further disseminated on the inguinal area. The ideal chemotherapy for the patient is liposomal doxorubicin however it is costly and not available in the institution. Alternative chemotherapy, which is less myelotoxic is weekly paclitaxel. The patient was monitored for treatment response and possible side effects.
Conclusion: It is critical to establish whether Kaposi sarcoma is localized or systemic in order to determine the appropriate treatment. Additional documentation and response to treatment of PLHIV with Kaposi sarcoma is necessary to further optimize treatment and able anticipation of complications.