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

Rare Presentation of Pulmonary Kaposi Sarcoma in a Non-HIV Patient FREE TO VIEW

Omar Ahmed, MD; Micah Fisher, MD
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Emory University, Decatur, GA

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

Chest. 2016;150(4_S):759A. doi:10.1016/j.chest.2016.08.854
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SESSION TITLE: Student/Resident Case Report Poster - Lung Cancer II

SESSION TYPE: Student/Resident Case Report Poster

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

INTRODUCTION: Kaposi sarcoma (KS) is an angioproliferative malignancy mostly associated with AIDS butcan occur in non-HIV immunocompromised patients. Cutaneous involvement is the most common form in non-HIV patients while pulmonary involvement is overall rare. This is a case of biopsy proven KS incidentally noted during bronchoscopy in the trachea of a non-HIV patient.

CASE PRESENTATION: A 56 year old male with a history of peripheral T-cell lymphoma status post peripheral blood stem cell transplant complicated by intestinal graft-versus-host disease presented with two days of fevers to 100.3, chills, malaise and pleuritic chest pain. His medications included prednisone 15 mg daily and sirolimus 1 mg daily. His initial physical exam was remarkable for cachexia. Lung fields were clear to auscultation bilaterally. No skin lesions were appreciated. His complete blood count was significant for 1,300 white blood cells and 22,000 platelets with a hemoglobin of 8.0 gm/dL. Chest x-ray and subsequent CT scan showed a left upper lobe consolidation, as well as subpectoral and axillary lymphadenopathy suggestive of recurrence of his disease. Bronchoscopy was done with bronchoalveolar lavage of upper lobe consolidations. Airway evaluation showed two raised violaceous vascular-appearing lesions in the lateral wall of the upper trachea suspicious for Kaposi Sarcoma. A repeat physical exam was done showing a similar raised violaceous lesion on penile shaft. Punch biopsies of penile lesions were consistent with Kaposi Sarcoma. The patient was diagnosed with Kaposi Sarcoma, likely secondary to immunosuppression from medication to treat his graft-versus-host disease. He was treated for ten days for health-care associated pneumonia, and started on pegylated liposomal doxorubicin as outpatient.

DISCUSSION: This is a rare presentation of KS in a rare patient group. Majority of pulmonary KS cases have been described in cutaneous AIDS-related KS with only a few case reports of pulmonary KS in non-HIV patients. In non-HIV patients, the majority of the cases had widespread, mucocutaneous disease.2 Extrapolating from AIDS-related KS, pulmonary manifestation comprise endobronchial and/or parenchymal lesions, usually involving branching points of the lower airways and rarely seen in the trachea. Diagnosis is made by recognition of the classic violaceous, macular or papular lesions. 3

CONCLUSIONS: Pulmonary KS can be seen in non-HIV patients with limited cutaneous involvement, not typically described in the literature.

Reference #1: Yoo DJ, Lee KH, Munderi P, Shin KC, Lee JK. Clinical and bronchoscopic findings in Ugandans with pulmonary Kaposi's sarcoma. Korean J Intern Med. 2005;20.

Reference #2: Gasparetto TD, Marchiori E. Pulmonary involvement in Kaposi sarcoma: correlation between imaging and pathology Orphanet J Rare Dis. 2009;4:18

Reference #3: Meduri GU, Stover DE, Lee M, et al. Pulmonary Kaposi's sarcoma in the acquired immune deficiency syndrome. Clinical, radiographic, and pathologic manifestations. Am J Med 1986; 81:11.

DISCLOSURE: The following authors have nothing to disclose: Omar Ahmed, Micah Fisher

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