Makindo Medical Notes

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).