Carolinas Research Day 2021

Clinical Case-Based Studies

07 Warning Signs: Kaposi's Sarcome in a Late HIV Diagnosis

Arianne Kalra, OMSIV, Lindsay Tjiattas-Saleski, DO, Michelle Carney, MD

Edward Via College of Osteopathic Medicine-Carolinas, Spartanburg Regional Healthcare System (SRHS)

Abstract: Kaposi sarcoma (KS) is a vascular neoplasm considered an AIDS-defining illness, with a rate of occurrence of 12% in previously diagnosed patients. HHV-8 was later identified as the etiologic cause of all subtypes of KS, including non-HIV classical KS which has a prevalence of 5%. The purpose of this report is to describe the relationship of Kaposi sarcoma and its potential as an early sign of HIV prior to a positive test diagnosis in a patient, the pathogenesis, and steps that can be taken to prevent rapid disease progression. 29-year-old Black male with a past medical history of non-Hodgkin’s lymphoma, and Type 2 Diabetes Mellitus presented to an infectious disease clinic following a positive HIV test. He had papular,

hyperpigmented, nonpruritic lesions present on his lower extremities for the last six months. Multiple previous visits to the ED and treatment for eczema and cellulitis didn’t provide resolution. After initiating HAART therapy, his lesions continue to ascend to the groin with inguinal lymphadenopathy and edema from the knees to hip flexors. He was diagnosed with KS via biopsy. Chemotherapy was initiated, but lesions progressed to his colon and small intestines. He was admitted due to recurrent pleural effusions and atelectasis from pulmonary KS and expired from acute hypoxic respiratory failure. This patient has an unusual disease timeline of KS with rapid dissemination of disease to internal organs leading to pulmonary failure, despite chemotherapy

and prompt initiation of HAART treatment. This patient was a young male in a high-risk population, without regular preventative care. He was misdiagnosed multiple times, preventing proper therapy. He developed immune reconstitution inflammatory syndrome, which led to his death. There is no literature known for a patient with a similar timeline, but the progression of his condition, the immune reaction related to his treatment, and epidemiology of AIDS in the southeast US are well studied. The intention of this case study is to encourage providers to consider the whole person and not focus on singular symptomology that may have prevented the rapid deterioration of his case.

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