Lung Cancer: Student/Resident Case Report Poster - Lung Cancer I |

Unusual Presentation of Kaposi Sarcoma in HIV Patient Diagnosed With Blind Transbronchial Lung Biopsy FREE TO VIEW

Kaushal Patel, MD; Yousef Hattab, MD; Sulaiman Alhassan, MD; Opoku Adjapong, MD; Rajashekar Adurty, MD
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Allegheny General Hospital, Pittsburgh, PA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):751A. doi:10.1016/j.chest.2016.08.846
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SESSION TITLE: Student/Resident Case Report Poster - Lung Cancer I

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Disseminated Kaposi sarcoma (KS) is a common complication of the acquired immune deficiency syndrome (AIDS) and usually starts as mucocutaneous lesions. Lung involvement in absence of mucocutaneous lesions is rare and is difficult to diagnose. So far, only few cases of pulmonary KS have been diagnosed by biopsy of visible endobronchial lesions. To our knowledge, this is the second reported case of pulmonary KS diagnosed with blind transbronchial lung biopsy in absence of endobronchial lesions.

CASE PRESENTATION: 55 years old male with history of HIV presented to ER with severe dyspnea and 8 lbs weight gain for a week. Chest CT scan showed septal and peribronchovascular thickening with ground-glass opacities and mediastinal lymph node enlargement. With a differential diagnosis of pulmonary edema, pneumocystis carinii pneumonia (PCP), atypical infection and lymphoma, patient underwent bronchoscopy that did not show any endobronchial lesion. Endobronchial ultrasound and transbronchial needle aspiration of lymph nodes 4L, 7, 10R and transbronchial biopsy from right lower lobe(RLL) was obtained. Pathology from RLL showed an atypical spindle cell proliferation positive for CD31, factor VIII, D2-40, CD34 and HHV 8 stain diagnostic for KS. Patient was promptly started on chemotherapy.

DISCUSSION: Pulmonary involvement in KS is rare in absence of mucocutaneous lesions. Our patient presented with respiratory failure, which is rare as a initial presentation and diagnosis was made through blind lung biopsy. Presentation of pulmonary KS is indistinguishable from opportunistic pneumonia and open lung biopsy has been advocated for diagnosis. Bronchoscopy is very low yield to diagnose pulmonary KS, but occasionally shows violaceous endobronchial lesions that may suggest parenchymal involvement.In our knowledge, there is only one other case reported where pulmonary KS was diagnosed by blind transbronchial biopsy in absence of endobronchial lesion.

CONCLUSIONS: •Our case demonstrated a rare presentation of KS where patient presented with respiratory failure and was diagnosed by transbronchial biopsy. •A high index of suspicion in HIV or immunocompromised patients who presents with persistent pulmonary infiltrate will aid in diagnosis. •Though it is not high yield procedure to diagnose pulmonary KS, transbronchial biopsy should be considered, even in absence of classic endobronchial lesions

Reference #1: Broderick PA, Krinsley JS. Pulmonary Kaposi disease diagnosis by transbronchial biopsy. Conn Med. 1990;54(10):555-7

Reference #2: Imran TF, Al-Khateeb Z, Jung J, Peters S, Dever LL. Pulmonary Kaposi sarcoma as the initial presentation of human immunodeficiency virus infection. IDCases. 2014;1(4):78-81.

DISCLOSURE: The following authors have nothing to disclose: Kaushal Patel, Yousef Hattab, Sulaiman Alhassan, Opoku Adjapong, Rajashekar Adurty

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