Chemotherapy Refractory Visceral And Disseminated AIDS Related Kaposi Sarcoma | 42688
Journal of Clinical Case Reports
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A 49-year-old male, one month prior diagnosed with AIDS, neurotoxoplasmosis and single cutaneous Kaposi Sarcoma (KS) lesion
was admitted with a 10 day-history of fever. Physical examination revealed bilateral cervical adenopathy, besides oropharyngeal
candidiasis. Ordinary laboratorial exams were innocent, but his latest CD4 count was 13 cells per mm3 and viral load was 113.417
copies per mL. Thorax and abdominal CT demonstrated diffuse lymphadenomegaly. Due to the oropharyngeal candidiases he was
submitted to an upper gastrointestinal endoscopy (UGE) to investigate esophageal involvement. Although we expected to find more
candidiases lesions, the UGE verified diffuse violaceous plaques in esophagus mucosa. Few days later patient developed severe
diarrhea but despite of a comprehensive non-invasive investigation the etiology was not elucidated. Therefore, a colonoscopy was
performed, demonstrating mucosal violaceous lesions, similar to those of the UGE. Concurrently to that investigation, the patient
was submitted to a lymph node biopsy. The histopathological results confirmed the suspicion of KS. Thus, the patient was diagnosed
with AIDS related Kaposi sarcoma with visceral and cutaneous disseminated manifestations, classified as stage T1I1S1 by ACTG
criteria. Because of high rates of morbimortality associated with this stage, chemotherapy with paclitaxel was initiated, although the
appropriate treatment was applied, the patient’s status over the following weeks declined, worsening CD4 count (4 cells/mm3) and
developing more skin lesions in a rapidly progressive pattern. Hence, this case report suggests that chemotherapy in patients with
highly impaired immunological functions may not have a successful outcome, reinforcing the importance of immune reconstitution
in AIDS related KS treatment.
Amanda Vieira is currently a Medical Students at the Federal University of Rio de Janeiro (UFRJ) and Intensive Medicine Intern at Rios D`or Hospital (HRD), a part of the D`or Institute.