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Pulmonary Kaposi ’s sarcoma in a female patient: Case report
Rev Assoc Med B ras 2016; 62(5):395-398 395
IMAGE IN MEDICINE
Pulmonary Kaposi’s sarcoma in a female patient: Case report
Natacha Calheiros de Lima Petribu1*, Mayana Silva Cisneiros2, Glauber Barbosa de Carvalho3, Lucyana de Melo Baptista 4
1MSc -- MD and Professor of Radiology and Diagnostic Imaging, Hospital Barão de Lucena, Recife, PE, Brazil
2Graduate degree – MD, Radiologist, Hospital Barão de Lucena, Recife, PE, Brazil
3Graduate student – Resident Physician in Radiology and Diagnostic Imaging, Hospital Barão de Lucena, Recife, PE, Brazil
4Graduate degree – MD, Medical Clinic and Cardiology Resident, Hospital Barão de Lucena, Recife, PE, Brazil
Summary
Study conducted at Hospital Barão de
Lucena, Recife, PE, Brazil
Article received: 7/5/2015
Accepted for publication: 7/6/2015
*Correspondence:
Address: Av. Caxangá, 3860
Iputinga
Recife, PE – Brazil
Postal code: 50731-005
Phone: +55 81 3184-6400
Kaposi’s sarcoma (KS) is a multicentric lymphoproliferative malignancy. Most
of the time this tumor is confined to the skin and subcutaneous tissue, but it
can present with widespread visceral involvement, such as in the lung. Pulmo-
nary KS is the most frequent form in young adult males, in a ratio of 15:1. The
disease usually affects individuals with low CD4 lymphocyte counts (<150-200
cells/mm³). We report a case of a female patient aged 35 years, with the presence
of skin lesions, self-limiting episodes of diarrhea and weight loss of 15 kg for
nearly 9 months, progressing to persistent fever. AIDS was diagnosed and biop-
sy of the lesions revealed Kaposi’s sarcoma. Computed tomography of the chest
showed peribronchovascular thickening, areas of ground glass opacity, conden-
sations with air bronchograms surrounded by ground glass opacity (halo sign)
and bilateral pleural effusion. The diagnosis of pulmonary KS is still a challenge,
especially due to the occurrence of other opportunistic diseases that may also
occur concurrently. Therefore, suspecting this diagnosis based on clinical and
laboratory manifestations, and even more with CT findings, is fundamental, es-
pecially in patients who already have the cutaneous form of the disease.
Keywords: Kaposi’s sarcoma, HIV, acquired immunodeficiency syndrome, lung.
Introduction
Kaposi’s sarcoma (KS) was first described in 1872 by
Moritz Kaposi as “idiopathic multiple pigmented sarco-
ma of the skin”. It is a multicentric lymphoproliferative
malignancy macroscopically characterized by the devel-
opment of grape-like tumors, often raised. Most of the
time these tumors are limited to the skin and subcuta-
neous tissue, but they may present with widespread vis-
ceral involvement.1
The disease usually affects individuals with low CD4
lymphocyte counts (<150-200 cells/mm³). The sites most
affected by visceral involvement in AIDS-related KS are
lymph nodes (72% of cases), lung (51%), gastrointestinal
tract (48%), liver (34%) and spleen (27%). Thoracic involve-
ment may include trachea, lymph vessels, pleura and lung
parenchyma.2,3
Case report
J.M.S., 35, female, admitted into Hospital Barão de Luce-
na due to the presence of purplish lesions on the face,
trunk, limbs, palate and right external ear, episodes of self-
limiting diarrhea, and weight loss of approximately 15 kg
in the course of approximately 9 months. AIDS diagno-
sis was made based on rapid HIV testing with serologic
confirmation by ELISA. The patient’s CD4 lymphocyte
count was 64 cells/mm³. Biopsy of the lesions with histo-
pathological examination revealed Kaposi’s sarcoma.
She had to be hospitalized due to fever and the pres-
ence of bullous impetigo and cellulitis in her left foot,
treated with empiric antibiotic therapy with cephalothin.
At the time, screening for other sites of infection was neg-
ative. There was no clinical improvement and therefore
we chose to broaden the antibiotic therapy with cipro-
floxacin and clindamycin. However, the patient contin-
ued to have daily fever peaks.
The culture of secretion from the impetigoid lesions
showed growth of ciprofloxacin-resistant Pseudomonas pseu-
doalcaligenes, and thus cefepime was started with subse-
quent association of vancomycin due to persistent fever.
Antiretroviral therapy was introduced with tenofovir,
lamivudine and efavirenz. Kaposi’s sarcoma staging was
also requested. Upper endoscopy revealed esophageal can-