SHM Converge Scientific Abstract ePoster Gallery-Kaposi Sarcoma in a Patient With Normal Cd4 Who Is Platelet Poor

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This case report describes a 19-year-old male who presented with fatigue, night sweats, weight loss, and diffuse lymph node swelling. He was found to have newly diagnosed HIV infection with a very high viral load and a normal CD4 count of 580/mm3, along with Kaposi sarcoma (KS) involving lymph nodes. He was transferred for evaluation of severe, refractory thrombocytopenia.<br /><br />Although KS has traditionally been viewed as an AIDS-defining illness associated with low CD4 counts, this case highlights that KS can occur even when CD4 counts are normal or elevated. The patient also had petechiae and ecchymoses, and workup ultimately showed no bone marrow KS involvement or other clear cause of cytopenias. Hematology diagnosed HIV-associated immune thrombocytopenia (ITP).<br /><br />Management was complicated because treatment for KS and thrombocytopenia could worsen one another. Rituximab might improve ITP but risked worsening KS, while doxorubicin is used for KS but can further suppress platelets. The patient later developed Kaposi sarcoma inflammatory cytokine syndrome (KICS), a serious KS-associated inflammatory complication. He was successfully treated with a combination of doxorubicin, rituximab, and romiplostim, which improved his platelet count and allowed discharge with follow-up.<br /><br />The main lessons are that KS should not be excluded solely because CD4 counts are high, KS may present concurrently with HIV diagnosis, and thrombocytopenia in this setting requires careful evaluation. In complex cases like this, combined therapy may be needed to balance control of KS and stabilization of platelets.

Asset Subtitle

Jason McLean

Meta Tag

Author List Amisha S. Mehta, Annie Massart, Jason McLean, Julia R. Schiff

Category Clinical Vignettes

Concept Kaposi Sarcoma

Concept HIV Coinfection

Concept Thrombocytopenia

Concept Lymphadenopathy

Concept CD4 Count

Distinguished Non-Finalist

Presenter Organization Emory University School of Medicine

Presenting Author Jason McLean

Track Adult

Keywords

Kaposi sarcoma

HIV infection

normal CD4 count

immune thrombocytopenia

thrombocytopenia

lymphadenopathy

KICS

rituximab

doxorubicin

romiplostim

Kaposi Sarcoma

HIV Coinfection

Thrombocytopenia

Lymphadenopathy

CD4 Count