SHM Converge Scientific Abstract ePoster Gallery-What's on the Inside That Counts: Delayed Diagnosis of Visceral Kaposi Sarcoma

Pdf Summary

This case describes a 28-year-old man with newly diagnosed, untreated HIV and advanced immunosuppression who presented with severe shortness of breath and acute respiratory failure. He was initially treated for presumed bacterial pneumonia and Pneumocystis jirovecii pneumonia (PJP) with broad-spectrum antibiotics, high-dose steroids, and later antiretroviral therapy (ART). Although he initially improved, his respiratory status later worsened.<br /><br />Imaging showed diffuse bilateral pulmonary micronodules and consolidation, raising concern for infection, but the diagnosis proved to be visceral Kaposi sarcoma (KS). Clues emerged when violaceous nodules were noticed behind the ear and on the face. A skin biopsy confirmed KS, and bronchoscopy demonstrated KS lesions in both bronchi. BAL testing was positive for human herpesvirus-8, supporting pulmonary KS.<br /><br />The report highlights several important points: pulmonary KS can closely mimic opportunistic infections and may occur alongside them, especially in patients with low CD4 counts. Corticosteroids, often used for suspected PJP, can worsen KS. ART initiation may also trigger immune reconstitution inflammatory syndrome (IRIS), which can temporarily aggravate KS-related symptoms.<br /><br />Management of visceral KS includes ART, stopping corticosteroids when possible, and chemotherapy such as liposomal anthracyclines for severe disease. Despite treatment with doxorubicin, the patient died from progressive respiratory failure.<br /><br />The key lesson is that in patients with advanced HIV and unexplained or worsening respiratory disease, clinicians should maintain a high suspicion for non-infectious causes like KS. Careful skin examination can provide crucial diagnostic clues, and involving the interprofessional team, including critical care nurses, may improve detection of subtle findings.

Asset Subtitle

Peter Barish

Meta Tag

Author List Andrew D. Auerbach, Armond Esmaili, Cynthia Fenton, Katie E. Raffel, Molly A. Kantor, Peter Barish

Category Clinical Vignettes

Concept Visceral Kaposi Sarcoma

Concept Advanced HIV

Concept Violaceous Skin Change

Concept HIV Therapy

Concept CD4 Count

Distinguished Non-Finalist

Presenter Organization University of California, San Francisco

Presenting Author Peter Barish

Track Adult

Keywords

HIV

Kaposi sarcoma

pulmonary KS

respiratory failure

Pneumocystis jirovecii pneumonia

human herpesvirus-8

antiretroviral therapy

immune reconstitution inflammatory syndrome

corticosteroids

visceral Kaposi sarcoma

Visceral Kaposi Sarcoma

Advanced HIV

Violaceous Skin Change

HIV Therapy

CD4 Count