Isolated Unilateral Pulmonary Kaposi Sarcoma

Abstract

INTRODUCTION: Kaposi Sarcoma (KS) is the most common tumor among AIDS patients, and is considered to be an AIDS-defining illness. Patients with pulmonary KS commonly present with mucocutaneous lesions and bilateral lung involvement. Atypical presentations are important to recognize. We present a patient with unilateral pulmonary KS without other mucocutaneous lesions. CASE PRESENTATION: A 40 year old male with a past medical history of Hepatitis B and C, polysubstance abuse and AIDS, non-complaint on HAART, with a CD4 count of 62 cells/mm3, was admitted with shortness of breath and cough. Over the last 5 months, the patient has had repeated hospitalizations and has been treated for recurrent pneumonia with broad spectrum antibiotics. Bronchoscopy was discussed but the patient refused. He again presented with worsening dry cough and dyspnea, without hemoptysis, gastrointestinal symptoms, sick contacts or recent travel. On examination he had a cachectic appearance, though was in no apparent distress and vital signs were stable. Lung exam revealed ronchorous breath sounds on the right. The remainder of his exam including skin inspection was unrevealing. Blood tests demonstrated a leukocytosis. Cultures for microorganisms and mycobacterium tuberculosis were negative. Chest x-ray showed right lung opacities, similar to prior studies. A CT scan of the chest showed persistent right lower and middle lobe consolidation. Bronchoscopy was again advised, and this time the patient consented. Airway inspection revealed a narrowed right lower lobe with nodular mucosa but patent airways. Bronchial biopsy revealed pulmonary KS. DISCUSSION: Pulmonary KS is indistinguishable from pulmonary opportunistic infections. Presentation typically includes progressive dyspnea, cough, and sometimes hemoptysis and fever. CT chest findings are usually described as multiple, bilateral flame-shaped or nodular lesions with ill-defined margins distributed along bronchovascular bundles, with or without thoracic lymphadenopathy and pleural effusion. Unilateral nodular lesions or consolidations are rare. Furthermore, pulmonary manifestation without other mucocutaneous involvement is also uncommon. Although a tissue diagnosis is not required to establish the diagnosis of pulmonary KS, a biopsy is necessary if the clinical, radiographic, and/or bronchoscopic picture is atypical. Treatment usually involves HAART with chemotherapy. CONCLUSION(S): Pulmonary KS should be considered in patients with AIDS presenting with recurrent pneumonia. While usually bilateral, patients can present with unilateral infiltration and may not have extra-pulmonary muocutaneous lesions.