• View in gallery

    Lymphedema, violaceous nodules, and warty appearance of the lower limbs. This figure appears in color at www.ajtmh.org.

  • View in gallery

    Colesional Kaposi sarcoma (inset displays HHV-8 immunoreactivity) and cryptococcosis (H&E stain at ×100 magnification). This figure appears in color at www.ajtmh.org.

  • View in gallery

    Colesional cryptococcosis (Alcian blue stain inset) and Kaposi sarcoma (H&E stain at ×200 magnification). This figure appears in color at www.ajtmh.org.

  • 1.

    Grayson W, 2008. The HIV-positive skin biopsy. J Clin Path 61: 802817.

  • 2.

    Grayson W, 2011. Recognition of dual or multiple pathology in skin biopsies from patients with HIV/AIDS. Pathol Res Int 2011: 398546.

  • 3.

    Ramdial PK, Sing Y, Subrayan S, Calonje E, 2010. Cutaneous colesional acquired immunodeficiency syndrome associated Kaposi sarcoma and cryptococcosis. Am J Dermatopathol 32: 780786.

    • Search Google Scholar
    • Export Citation
  • 4.

    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: 101106.

    • Search Google Scholar
    • Export Citation
  • 5.

    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: 480486.

    • Search Google Scholar
    • Export Citation
  • 6.

    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: 683684.

    • Search Google Scholar
    • Export Citation
  • 7.

    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: 159162.

    • Search Google Scholar
    • Export Citation
  • 8.

    Ramdial PK, 2010. Dermatopathological challenges in the human immunodeficiency virus and acquired immunodeficiency syndrome era. Histopathology 56: 3956.

    • Search Google Scholar
    • Export Citation

 

 

 

 

 

Colesional Cutaneous Kaposi Sarcoma and Cryptococcosis

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  • 1 Anatomical Pathology, National Health Laboratory Service, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;
  • 2 Department of Dermatology, Gauteng Department of Health, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

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).

Figure 1.
Figure 1.

Lymphedema, violaceous nodules, and warty appearance of the lower limbs. This figure appears in color at www.ajtmh.org.

Citation: The American Journal of Tropical Medicine and Hygiene 104, 2; 10.4269/ajtmh.20-1097

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).

Figure 2.
Figure 2.

Colesional Kaposi sarcoma (inset displays HHV-8 immunoreactivity) and cryptococcosis (H&E stain at ×100 magnification). This figure appears in color at www.ajtmh.org.

Citation: The American Journal of Tropical Medicine and Hygiene 104, 2; 10.4269/ajtmh.20-1097

Figure 3.
Figure 3.

Colesional cryptococcosis (Alcian blue stain inset) and Kaposi sarcoma (H&E stain at ×200 magnification). This figure appears in color at www.ajtmh.org.

Citation: The American Journal of Tropical Medicine and Hygiene 104, 2; 10.4269/ajtmh.20-1097

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.37 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.

REFERENCES

  • 1.

    Grayson W, 2008. The HIV-positive skin biopsy. J Clin Path 61: 802817.

  • 2.

    Grayson W, 2011. Recognition of dual or multiple pathology in skin biopsies from patients with HIV/AIDS. Pathol Res Int 2011: 398546.

  • 3.

    Ramdial PK, Sing Y, Subrayan S, Calonje E, 2010. Cutaneous colesional acquired immunodeficiency syndrome associated Kaposi sarcoma and cryptococcosis. Am J Dermatopathol 32: 780786.

    • Search Google Scholar
    • Export Citation
  • 4.

    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: 101106.

    • Search Google Scholar
    • Export Citation
  • 5.

    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: 480486.

    • Search Google Scholar
    • Export Citation
  • 6.

    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: 683684.

    • Search Google Scholar
    • Export Citation
  • 7.

    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: 159162.

    • Search Google Scholar
    • Export Citation
  • 8.

    Ramdial PK, 2010. Dermatopathological challenges in the human immunodeficiency virus and acquired immunodeficiency syndrome era. Histopathology 56: 3956.

    • Search Google Scholar
    • Export Citation

Author Notes

Address correspondence to Sugeshnee Pather, Anatomical Pathology, National Health Laboratory Service, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Office 108, Level 4, NHLS, Chris Hani Road, Diepkloof, Soweto 1864, Gauteng Province, South Africa. E-mail: sugeshnee.pather@nhls.ac.za

Disclosure: Ethics approval for this article was obtained from the Human Research Ethics Committee at the University of the Witwatersrand (certificate number: M171087), and written consent for publication was obtained from the patient.

Authors’ addresses: Abdullah Ismail and Sugeshnee Pather, Anatomical Pathology, National Health Laboratory Service, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, E-mails: abdullah.ismail@nhls.ac.za and sugeshnee.pather@nhls.ac.za. Silindile Sibisi, Department of Dermatology, Gauteng Department of Health, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, E-mail: shangelindi@gmail.com.

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