Herein, we present a rare case of colesional cutaneous acquired immunodeficiency syndrome-related Kaposi sarcoma (KS) and cryptococcosis in an adult male. Histopathological examination of persistent or progressive cutaneous lesions, occurring in the context of human immunodeficiency (HIV) infection, is likely to detect potentially life-threatening opportunistic infection (OIs) and/or neoplasia.
A 38-year-old man presented at the largest hospital in Africa with 6 years’ history of progressive lower limb swelling and cutaneous lesions. The patient was seropositive HIV and antiretroviral therapy naive. Physical examination confirmed his generally unwell status due to emaciation, generalized lymphadenopathy, and massive lymphedema of the lower limbs. Hyperpigmented plaques on the legs were intermixed with violaceous nodules. A prominent warty appearance and toenail destruction were evident (Figure 1). The clinical differential diagnosis included KS and acroangiodermatitis of Mali (pseudo-KS).
The HIV viral load was 4,75,000 copies/mL, the CD4 count was 5 cells/µL, and a positive serum cryptococcal latex agglutination test was confirmed. Histopathological examination of a skin lesion confirmed the presence of colesional KS and cryptococcosis (Figures 2 and 3).
Antiretroviral therapy and antifungal therapy were initiated. Unfortunately, death ensued while this patient was hospitalized.
Cutaneous manifestations of HIV may develop in more than 90% of infected individuals.1,2 However, the co-existence of KS and cryptococcosis within a cutaneous lesion is a very rare occurrence.3–7 Although antiretroviral therapy has led to a reduction in the incidence of KS and OIs, these continue to be the presenting conditions in the context of undiagnosed HIV infection. Contributing factors may also include suboptimal access to healthcare, nonadherence to antiviral therapy, or drug resistance. The presence of OIs is often an indicator of severe immunosuppression with disseminated disease. Therefore, the recognition of cutaneous involvement by OIs should expedite access to treatment.8
This report contributes to the expanding spectrum of colesional cutaneous pathology that manifests because of HIV-induced immunosuppression.
Grayson W, 2011. Recognition of dual or multiple pathology in skin biopsies from patients with HIV/AIDS. Pathol Res Int 2011: 398546.
Ramdial PK, Sing Y, Subrayan S, Calonje E, 2010. Cutaneous colesional acquired immunodeficiency syndrome associated Kaposi sarcoma and cryptococcosis. Am J Dermatopathol 32: 780–786.
Berthaud V, Navarro C, 2001. Fatal unrecognized cutaneous and systemic Kaposi’s sarcoma in an AIDS patient with acute cryptococcal meningoencephalitis. Int J Infect Dis 5: 101–106.
Glassman SJ, Hale MJ, 1995. Cutaneous cryptococcosis and Kaposi’s sarcoma occurring in the same lesions in a patient with the acquired immunodeficiency syndrome. Clin Exp Dermatol 20: 480–486.
Sofman MS, Heilman ER, 1990. Simultaneous occurrence of Kaposi’s sarcoma and cryptococcus within a cutaneous lesion in a patient with acquired immunodeficiency syndrome. Arch Dermatol 126: 683–684.
Libow L, Dobert D, Dibulkin D, 1988. Co-existent cutaneous cryptococcosis and Kaposi’s sarcoma in a patient with the acquired immunodeficiency syndrome. Cutis 41: 159–162.
Ramdial PK, 2010. Dermatopathological challenges in the human immunodeficiency virus and acquired immunodeficiency syndrome era. Histopathology 56: 39–56.