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Colbert RD, Gaya D, Hale G, Rickaby W. Cutaneous Kaposi's sarcoma in an HIV-negative patient with Crohn's disease on thiopurine immunosuppression. BMJ Case Rep 2021; 14:e245321. [PMID: 34764119 PMCID: PMC8587592 DOI: 10.1136/bcr-2021-245321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 11/04/2022] Open
Abstract
We present the rare case of a 61-year-old man with Crohn's disease who developed a cutaneous Kaposi's sarcoma in the setting of long-term treatment with 6-mercaptopurine. Deciding on the best course of management provided a clinical challenge in an 'evidence-light' area. Relevant case reports and guidelines were reviewed. In general, the withdrawal of immunosuppressive therapy is advised; however, a multidisciplinary, case-by-case approach is also emphasised. The patient's lesion was removed and, following collaborative discussion, immunosuppression was continued post resection. This is thought to be the first reported case involving a Kaposi's sarcoma in inflammatory bowel disease where immune therapy was not subsequently discontinued.
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Affiliation(s)
| | - Daniel Gaya
- Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - Gordon Hale
- Dermatology, Glasgow Royal Infirmary, Glasgow, UK
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Clinicopathologic Correlation of Kaposi Sarcoma Involving the Ocular Adnexa: Immunophenotyping of Diagnostic and Therapeutic Targets. Ophthalmic Plast Reconstr Surg 2021; 36:185-190. [PMID: 31743287 DOI: 10.1097/iop.0000000000001506] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To describe the clinicopathologic characteristics and the expression of diagnostic/treatment targets in ocular adnexal Kaposi Sarcoma. METHODS We conducted a clinical-pathologic retrospective case series. Immunohistochemical staining for cluster of differentiation 31 (CD31), human herpesvirus-8 (HHV8), platelet-derived growth factor receptor alpha (PDGFR-A), vascular endothelial growth factor receptor-1 (VEGF), tyrosine-protein kinase Kit (c-Kit), and programmed cell death protein 1 (PD-1) were performed. Percentage of positive tumor cells was recorded for PD-1; staining intensity and distribution (H-score) were determined for the remaining stains. A Friedman non-parametric ANOVA analysis evaluated the staining. RESULTS The study cohort included 13 patients (age 25 to 95 years; mean 46): 7 lesions were in the eyelid, 5 in the conjunctiva, and 1 in the cornea. Nine of 11 lesions (82%) were in human immunodeficiency syndrome-positive patients (human immunodeficiency syndrome status was unknown in 2 cases). Staging included 6 plaques and 7 nodules. The mean H-scores of CD31, HHV8, c-Kit, VEGF, and PDGF-A were 8.00, 8.23, 2.77, 11.54, and 10.31, respectively. Mean PD-1 staining was 6.46%. The Friedman non-parametric ANOVA analysis showed VEGF, PDGF-A, CD31, and HHV8 differed significantly, and all differed significantly from c-Kit. Programmed cell death protein 1 staining was not significant with any clinical variable. CONCLUSIONS Cluster of differentiation 31 and HHV8 are helpful diagnostic adjuncts for ocular adnexal Kaposi Sarcoma. Platelet-derived growth factor receptor alpha and VEGF are promising treatment targets. Programmed cell death protein 1/PD-L1 and c-Kit are targets that are useful in several tumors; their roles in ocular adnexal Kaposi Sarcoma warrant further studies.
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Tiong BK, Singh AS, Sarantopoulos GP, Kermani TA. Kaposi sarcoma in anti-neutrophil cytoplasmic antibody-associated vasculitis: a case-based review. Rheumatol Int 2021; 41:1357-1367. [PMID: 33620515 PMCID: PMC8164621 DOI: 10.1007/s00296-021-04810-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/06/2021] [Indexed: 12/19/2022]
Abstract
Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) are systemic necrotizing vasculitides associated with significant morbidity and mortality. Given the immunosuppression used to manage these conditions, it is important for clinicians to recognize complications, especially infectious ones, which may arise during treatment. Kaposi sarcoma (KS) is a lymphoangioproliferative neoplasm caused by human herpes virus 8 (HHV-8). Its cutaneous manifestations can mimic vasculitis. We describe a 77-year-old man with microscopic polyangiitis with pulmonary-renal syndrome treated with prednisone and intravenous cyclophosphamide who developed KS (HHV-8 positive) after 2 months of treatment. Cyclophosphamide was discontinued and prednisone gradually lowered with improvement and clinical stabilization of KS lesions. This comprehensive review includes all published cases of KS in patients with AAV, with a goal to summarize potential risk factors including the clinical characteristics of vasculitis, treatment and outcomes of patients with this rare complication of immunosuppressive therapy. We also expanded our literature review to KS in other forms of systemic vasculitis. Our case-based review emphasizes the importance of considering infectious complications of immunosuppressive therapy, especially glucocorticoids, and highlights the rare association of KS in systemic vasculitis.
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Affiliation(s)
- Benedict K Tiong
- Division of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, 2020 Santa Monica Boulevard, Suite 540, Santa Monica, CA, 90404, USA.
| | - Arun S Singh
- Division of Hematology and Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - G Peter Sarantopoulos
- Department of Pathology and Laboratory Medicine, UCLA Medical Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tanaz A Kermani
- Division of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, 2020 Santa Monica Boulevard, Suite 540, Santa Monica, CA, 90404, USA
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Abstract
Abstract
Background: Behcet’s disease (BD) is a chronic, inflammatory multisystemic condition of unknown etiology. Although the cause of BD is not clear, it is believed to be the result of an autoimmune process triggered by an infectious or environmental agent (possibly local to a geographic region) in a genetically predisposed individual.
Objective: To detail current knowledge of the role of microorganisms in the pathogenesis of BD and review the infectious etiology of this disease.
Methods: The review based on publication in SCOPUS, Science direct, and PubMed.
Results: A microbial infection has been implicated in the development of the disease to explain the strong inflammatory reactions observed, the activation of monocytes and macrophages, and the induction of proinflammatory cytokines and chemokines detected. Common factors linking some of the possible pathogenetic agents are extrinsically induced tissue stress or heat shock proteins, which react with host tissues and elicit significant T-helper type 1 cell responses.
Conclusion: Based on collected data, we conclude that the microorganisms discussed seem to participate and, at least in part, act as triggers during the course of BD. By clarifying the microbial associations of BD and finding its etiology, particularly the causative antigens leading to BD, it would be easier to suggest more effective treatment and preventive strategies for this disease.
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Affiliation(s)
- Fatemeh Dabbagh
- Department of Pharmaceutical Biotechnology, Shiraz University of Medical Sciences, Shiraz 71345-1583, Iran Iran (Islamic Republic of)
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz 71345-1583, Iran (Islamic Republic of)
| | - Afshin Borhani Haghighi
- Department of Neurology, Shiraz University of Medical Sciences, Shiraz 71345-1583, Iran (Islamic Republic of)
| | - Younes Ghasemi
- Department of Pharmaceutical Biotechnology, Shiraz University of Medical Sciences, Shiraz 71345-1583, Iran Iran (Islamic Republic of)
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz 71345-1583, Iran (Islamic Republic of)
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Cordero-Coma M, Salazar-Méndez R, Yilmaz T. Treatment of severe non-infectious uveitis in high-risk conditions (Part I): pregnancy and malignancies, management and safety issues. Expert Opin Drug Saf 2015; 14:1071-86. [DOI: 10.1517/14740338.2015.1044969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Lin Y, Li G, Zheng W, Tian X, Zhang F. Behcet's disease associated with malignancy: a report of 41 Chinese cases. Int J Rheum Dis 2013; 17:459-65. [PMID: 24354961 DOI: 10.1111/1756-185x.12269] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify the clinical characteristics of Behcet's disease (BD) associated with malignancies. METHOD Among 651 BD patients sequentially hospitalized in Peking Union Medical College Hospital from 1995 to 2012, 41 patients developed malignancies. Clinical characteristics were compared between patients with and without malignancies, as well as between patients with hematological and solid malignancies. RESULTS The numbers of patients with various types of malignancies were listed as follows: (i) 29 cases developed hematologic malignancies which included myelodysplastic syndrome (MDS) as the most common diagnosis in 20 cases, leukemia in seven cases, anaplastic anemia in two cases and lymphoma in one case; (ii) 13 cases developed malignant solid neoplasms which included colorectal cancer in three cases, urothelial carcinoma of bladder in two cases, esophageal cancer, gastric cancer, pancreatic cancer, thyroid cancer, breast cancer, cervical cancer, renal cell carcinoma and metastatic adenocarcinoma of unknown primary in one case each. Female gender, older age and gastrointestinal tract involvement were more frequently observed among patients with malignancy than those without. Older age, longer disease duration were more commonly seen in BD patients with solid neoplasms than in those with hematologic malignancies. Exacerbation of BD manifestations during the emergence of malignancy was more frequently observed among patients with hematologic malignancies than among those with malignant solid neoplasms. CONCLUSION This study demonstrated that MDS and colorectal cancer were the most common hematologic malignancy and malignant solid neoplasm associated with BD, respectively. Gastrointestinal involvement is likely to be a risk factor for BD patients to develop malignancy. Further studies will be required to ascertain the pathogenic link between these two entities.
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Affiliation(s)
- Yi Lin
- Department of Oncology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, China
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Tocilizumab Monotherapy in a Patient with Rheumatoid Arthritis and Iatrogenic Kaposi Sarcoma. Clin Drug Investig 2013; 34:159-61. [DOI: 10.1007/s40261-013-0159-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Abstract
PURPOSE Behςet's disease (BD) is rarely reported to be associated with malignancies in the literature. However, the frequency of cancer in BD patients remains unknown. This study evaluated cancer morbidity in BD patients compared with that in the general population of Korea. MATERIALS AND METHODS A retrospective chart review was performed on 506 patients visiting our hospital from 1994 to 2011 for BD. We analyzed the standardized morbidity rate (SMR), which is the ratio of observed to expected malignancies. Furthermore, we reviewed cases of solid cancer in BD patients in the literature. RESULTS Of the 506 patients with BD, 11 (2.17%) developed cancer. We found a variety of solid cancers without predominance and no hematologic malignancies. The total number of cancers observed was less than expected, which was determined from the statistical data of the National Cancer Information Center of Korea, with an SMR of 0.023 (95% confidence interval, 0.012-0.039). CONCLUSION BD may be associated with a lower cancer-related morbidity compared with the general population of Korea.
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Affiliation(s)
- So Young Na
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - Jaeyoung Shin
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - Eun-So Lee
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
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Mat C, Yurdakul S, Sevim A, Özyazgan Y, Tüzün Y. Behçet’s syndrome: Facts and controversies. Clin Dermatol 2013; 31:352-361. [DOI: 10.1016/j.clindermatol.2013.01.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Krengel S, Satzger I, Alter M, Kapp A, Gutzmer R. [Remission of an iatrogenic Kaposi sarcoma in a patient with myasthenia gravis after switching immunosuppressive therapy to the mTOR inhibitor everolimus]. Hautarzt 2012; 63:573-6. [PMID: 22751858 DOI: 10.1007/s00105-011-2274-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Iatrogenic Kaposi sarcomas (KS) in organ transplant recipients are often treated by switching immunosuppressive therapy to an mTOR inhibitor, such as sirolimus or everolimus, as these have immunosuppressive as well as anti-tumor effects. We report on an 80-year-old male patient who developed a disseminated cutaneous KS during therapy with prednisone and azathioprine for myasthenia gravis. After discontinuation of azathioprine therapy and despite continuing therapy with cortisone, the KS progressed and autoantibody levels against the nicotinic acetylcholine receptor increased. During the administration of everolimus, a long-term near-complete remission of KS and a decrease in autoantibodies took place. This case study illustrates that even in non-organ transplant patients with iatrogenic KS, switching to immunosuppressive therapy using an mTOR inhibitor can be beneficial.
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Affiliation(s)
- S Krengel
- Klinik für Dermatologie, Allergologie und Venerologie, Hauttumorzentrum Hannover, Medizinische Hochschule Hannover, Deutschland.
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La maladie de Kaposi iatrogène au Maroc en dehors du contexte de la transplantation. Ann Dermatol Venereol 2011; 138:729-35. [DOI: 10.1016/j.annder.2011.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 04/24/2011] [Accepted: 06/28/2011] [Indexed: 11/20/2022]
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Ballonzoli L, Bourcier T. [Ocular side effects of steroids and other immunosuppressive agents]. Therapie 2010; 65:115-20. [PMID: 20478243 DOI: 10.2515/therapie/2010002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 01/02/2010] [Indexed: 11/20/2022]
Abstract
The increasing use of immunosuppressive (IS) drugs in transplants or in systemic diseases, implies a long period of treatment and to be aware of possible side effects. These drugs can be used alone or in combination with steroids. This review deals with the issue of ocular side effects of the most used IS drugs, including steroids. Data were collected from Medline using Pubmed software. We first describe specific complication of each drug and then conclude on major common toxicity represented by opportunistic infections and induced cancers.
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Changes in T-Cell Responses Against Human Herpesvirus-8 Correlate with the Disease Course of Iatrogenic Kaposi's Sarcoma in a Patient with Undifferentiated Arthritis. Semin Arthritis Rheum 2009; 39:170-5. [DOI: 10.1016/j.semarthrit.2008.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Revised: 05/14/2008] [Accepted: 05/24/2008] [Indexed: 11/20/2022]
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Schwartz RA, Micali G, Nasca MR, Scuderi L. Kaposi sarcoma: a continuing conundrum. J Am Acad Dermatol 2008; 59:179-206; quiz 207-8. [PMID: 18638627 DOI: 10.1016/j.jaad.2008.05.001] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Revised: 04/20/2008] [Accepted: 05/05/2008] [Indexed: 12/11/2022]
Abstract
UNLABELLED Kaposi sarcoma (KS) remains a challenge. Its classic or Mediterranean form tends to be benign. In transplant recipients it may be less so. As part of the AIDS pandemic, of which it was an original defining component, it may be life-threatening. It is due to human herpesvirus-8, which is necessary but not sufficient to produce the disease. KS has a low prevalence in the general population of the United States and United Kingdom, with an intermediate rate in Italy and Greece, and a high one in parts of Africa. In Italy, hot spots include its southern regions, the Po River Valley, and Sardinia, possibly related to a high density of blood-sucking insects. An important challenge is to treat KS patients without immunocompromising them. The potential of effective anti-herpes virus therapy and the use of sirolimus in transplantation recipients have added new opportunities for KS prevention. LEARNING OBJECTIVES At the conclusion of this learning activity, participants should be able to provide the most recent information about Kaposi sarcoma in the context in which it occurs. Its classic or Mediterranean form, its pattern in transplant recipients and others iatrogenically immunosuppressed, and its occurrence as a potentially life-threatening part of the AIDS pandemic will be stressed. Its etiology and transmission will be discussed in detail to facilitate understanding of Kaposi sarcoma and of human herpesvirus-8 infection in the general population of the United States and United Kingdom, in Italy and Greece, and in certain parts of Africa. Its therapy, including the concept of doing it without immunocompromising the patient, will be stressed. New opportunities for Kaposi sarcoma prevention will also be discussed.
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Affiliation(s)
- Robert A Schwartz
- Department of Dermatology, New Jersey Medical School, Newark, New Jersey 07103-2714, USA.
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