SHM Converge Scientific Abstract ePoster Gallery-A Rare Case of Kaposi Sarcoma-Immune Reconstitution Syndrome: The Double Edged Sword of Antiretroviral Initiation

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This case report describes a rare and severe complication of starting HAART in a patient with advanced HIV: Kaposi sarcoma immune reconstitution inflammatory syndrome (KS-IRIS). A 28-year-old man from Central America was diagnosed with HIV after relocating to Atlanta and began antiretroviral therapy. He later developed worsening dyspnea, pleural effusions, and progressive clinical decline. At an outside hospital, he stopped ARVs and was referred to hospice, but he was subsequently evaluated at Emory.<br /><br />Workup showed HIV-1 RNA of 61,000 copies and a CD4 count of 119 cells/µL. Skin biopsy confirmed Kaposi sarcoma, and imaging plus bronchoscopy suggested extensive disease involving the lungs and liver, including obstructive biliary involvement. Despite treatment efforts, his bilateral pleural effusions worsened, he required intubation for respiratory failure, and he later developed undifferentiated shock. Infectious workup was largely negative. He was started on doxorubicin for KS and ARVs were restarted, but his condition continued to deteriorate and he died on hospital day 22.<br /><br />The report emphasizes that KS is an AIDS-defining malignancy and that immune reconstitution after HAART can paradoxically trigger a systemic inflammatory response against a high tumor burden. KS-IRIS may present with rapid progression of skin lesions, worsening pulmonary disease, lymphedema, falling viral load, and rising CD4 count. Although HAART and chemotherapy can improve outcomes, KS-IRIS can be fatal, especially when disease burden is extensive.<br /><br />The authors stress early recognition of KS-IRIS and the importance of early goals-of-care discussions in patients with severe disseminated Kaposi sarcoma.

Asset Subtitle

Tony Z. Zhuang

Meta Tag

Author List Chloe Lalonde, Grace Haser, Jack Novack, Jeanne Ho, Nicole Lue, Simon Akhnoukh, Srihari Veeraraghavan, Tony Z. Zhuang, Zakaa Hassan

Category Clinical Vignettes

Concept HIV Therapy

Concept Immune Reconstitution Inflammatory Syndrome

Concept Kaposi SarcomaImmune Reconstitution Inflammatory Syndrome

Concept Kaposi Sarcoma

Concept Tumor Burden

Distinguished Non-Finalist

Presenter Organization Emory University

Presenting Author Tony Z. Zhuang

Track Adult

Keywords

Kaposi sarcoma

immune reconstitution inflammatory syndrome

KS-IRIS

HIV

HAART

antiretroviral therapy

pleural effusion

disseminated disease

doxorubicin

AIDS-defining malignancy

HIV Therapy

Immune Reconstitution Inflammatory Syndrome

Kaposi SarcomaImmune Reconstitution Inflammatory Syndrome

Kaposi Sarcoma

Tumor Burden