Related Subjects:
|AIDS HIV
|Kaposi sarcoma (KS)
📖 About
- 🎗️ Kaposi's sarcoma (KS) is a rare vascular malignancy, first seen in older men before the HIV era.
- 🧬 Now strongly associated with HIV infection and Human Herpesvirus 8 (HHV8).
- Common sites: skin, mucosa, lungs, GI tract, and lymph nodes.
🧬 Aetiology
- Caused by HHV8 infection in immunocompromised patients (especially with HIV).
- ⬇️ More common in patients with advanced HIV/AIDS or iatrogenic immunosuppression (e.g., post-transplant).
- Sexual transmission of HHV8 is important in HIV-related cases.
⚙️ Pathophysiology
- Likely originates from endothelial cells.
- 📈 Cytokine dysregulation → abnormal angiogenesis and vascular proliferation.
🩺 Clinical Features
- 🟣 Skin lesions: non-blanching, red–purple patches/plaques/nodules; often painless but may ulcerate; typically multifocal.
- 👄 Mucosal lesions: common in the mouth, nose, or pharynx.
- 🫁 Pulmonary involvement: haemoptysis, cough, chest pain, pleural effusion.
- 🍽️ GI involvement: dysphagia, abdominal pain, obstruction, weight loss.
- 🧾 Systemic: fever, lymphadenopathy, diarrhoea, wasting in advanced disease.
🔢 Forms of Kaposi’s Sarcoma
- 🌍 HIV-related (epidemic): most common, aggressive, linked to AIDS.
- 💊 Iatrogenic: post-transplant immunosuppression.
- 👴 Classic (sporadic): elderly men (Mediterranean/Jewish/Eastern European); slow progression.
- 🌴 Endemic (African): children/young adults in equatorial Africa; often aggressive.
🧾 Differential Diagnosis
- 🔬 Bacillary angiomatosis (Bartonella) → biopsy & treat with antibiotics.
🔎 Investigations
- 🧪 Skin biopsy = gold standard.
- 📊 FBC, U&E, ESR for baseline health.
- 🫁 CXR/CT for pulmonary involvement.
- 🧬 HIV testing (if status unknown).
⚕️ Systemic Management
- 💊 HAART → cornerstone in HIV-related KS; often leads to regression.
- ⬇️ Reduce immunosuppression in transplant patients if possible.
- 💉 Chemotherapy (e.g., liposomal doxorubicin) for extensive/systemic disease.
- 👴 In classic KS, conservative management may be reasonable unless complications arise (e.g., leg swelling → compression therapy).
🎯 Treating Symptomatic Lesions
- 🔆 Radiotherapy: useful for individual lesions.
- ❄️ Cryotherapy: liquid nitrogen for small lesions.
- 💡 Laser therapy: reduces pigmentation or lesion bulk.
- ☀️ Photodynamic therapy: topical light-sensitiser + light exposure.
- ✂️ Surgery: excision/curettage of isolated lesions.
- 💉 Intralesional therapy: immune-modulating agents injected directly.
- 🧴 Topical retinoids for cutaneous lesions.
- 🎨 Camouflage creams for cosmetic support post-treatment.
💡 Exam tip:
Think KS in an HIV+ patient with purplish, non-blanching skin or oral lesions.
Always distinguish from Bacillary angiomatosis (infective, antibiotic-responsive).
