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Oprita A, Cotan H, Celmare D, Emilescu R. Rituximab-Induced Kaposi Sarcoma in HIV-Negative Patients: A Narrative Review. Cureus 2023; 15:e45365. [PMID: 37849608 PMCID: PMC10578454 DOI: 10.7759/cureus.45365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2023] [Indexed: 10/19/2023] Open
Abstract
Kaposi sarcoma (KS) is a low-grade mesenchymal angioproliferative disorder that requires infection with human herpes virus 8 (HHV-8) for it to develop. It is commonly seen in HIV-positive patients and rarely in immunosuppressed HIV-negative patients. Rituximab is a monoclonal anti-CD20 chimeric murine/human immunoglobulin G antibody used to treat B cell lymphoproliferative diseases as well as a variety of autoimmune disorders. Several cases of iatrogenic Kaposi sarcoma (iKS) have been described after rituximab treatment. The purpose of this narrative review is to identify the presence of common clinical characteristics among rituximab-induced KS patients that could facilitate better management of this rare condition.
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Affiliation(s)
| | - Horia Cotan
- Oncology, Elias Emergency University Hospital, Bucharest, ROU
| | - Dana Celmare
- Oncology, Saint Nicholas Medical Center, Pitesti, ROU
| | - Radu Emilescu
- Endocrinology, Diabetes and Metabolism, C.I. Parhon National Institute of Endocrinology, Bucharest, ROU
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2
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Balighi K, Ghiasi M, Aryanian Z, Nikyar Z, Hatami P. Kaposi's sarcoma in a patient with pemphigus vulgaris mimicking exacerbation of pemphigus. Cancer Rep (Hoboken) 2023; 6:e1815. [PMID: 37002662 PMCID: PMC10172168 DOI: 10.1002/cnr2.1815] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Kaposi's sarcoma (KS) is a rare multifocal angiogenic tumor often seen in immunocompromised setting such as acquired immunodeficiency syndrome (AIDS) or organ transplantation recipients. Pemphigus vulgaris (PV) is a rare blistering disorder with mucocutaneous involvement for which immunosuppressive therapy has long been the core of treatment. Iatrogenic form of KS has been reported infrequently in pemphigus patients as a result of long-term immunosuppressive therapy. CASE We describe a 39-year-old male patient with confirmed diagnosis of PV who developed KS after receiving immunosuppressive agents for his pemphigus. KS was initially localized to the oral cavity with features mimicking exacerbation of his pemphigus. CONCLUSION This interesting case of KS suggests that dermatologists visiting patients with pemphigus with discomfort in the oral cavity should have a high degree of awareness and consider other differential diagnoses along with merely an exacerbation of PV.
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Affiliation(s)
- Kamran Balighi
- Autoimmune Bullous Diseases Research Center Tehran University of Medical Sciences 1199663911 Tehran Iran
- Department of Dermatology, School of Medicine, Razi Hospital Tehran University of Medical Sciences 1199663911 Tehran Iran
| | - Maryam Ghiasi
- Autoimmune Bullous Diseases Research Center Tehran University of Medical Sciences 1199663911 Tehran Iran
- Department of Dermatology, School of Medicine, Razi Hospital Tehran University of Medical Sciences 1199663911 Tehran Iran
| | - Zeinab Aryanian
- Autoimmune Bullous Diseases Research Center Tehran University of Medical Sciences 1199663911 Tehran Iran
- Department of Dermatology, School of Medicine, Razi Hospital Tehran University of Medical Sciences 1199663911 Tehran Iran
- Department of Dermatology Babol University of Medical Sciences 47176_47745 Babol Iran
| | - Zahra Nikyar
- Department of Dermatology, School of Medicine, Pediatric Dermatology Fellowship, Razi Hospital Tehran University of Medical Sciences 1199663911 Tehran Iran
| | - Parvaneh Hatami
- Autoimmune Bullous Diseases Research Center Tehran University of Medical Sciences 1199663911 Tehran Iran
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3
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Brambilla L, Maronese CA, Zelin E, Genovese G, Tourlaki A. Kaposi's sarcoma, biologics and small molecules: Navigating the complex interplay between host immunity and viral biology. A case series with focused review of the literature. Dermatol Ther 2021; 35:e15278. [PMID: 34931407 DOI: 10.1111/dth.15278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 01/01/2023]
Abstract
The consequences of cytokine-specific immune modulation in the development and course of Kaposi's sarcoma (KS) are poorly understood. A retrospective chart review of patients treated with biologic/small molecule drugs and followed at the dedicated KS outpatient service of our Dermatology Unit was performed. The literature on biologic and small molecule drug use in KS patients was also reviewed. Data concerning 12 KS patients treated with biologic/small molecule drugs were collected. After a median delay of 6 months following biologic or small molecule drug introduction, nine patients experienced either KS onset or reactivation. Drugs associated with KS onset or flaring were: rituximab, infliximab, ruxolitinib apremilast (1), mirikizumab, abatacept (1). After a median follow-up of 25 months, all cases achieved persistent complete response through culprit drug discontinuation or drug withdrawal plus treatment. No effect on KS course was recorded with tocilizumab and vedolizumab. Based on our experience with the largest case series reported to date as well as the available literature, tocilizumab and ustekinumab seem to exert an overall neutral effect on KS. On the other hand, rituximab, infliximab, and ruxolitinib have been associated with the development or worsening of pre-existing KS and should be carefully pondered before use. Due to limited and partly controversial evidence, no definitive conclusions can be drawn on vedolizumab, apremilast, mirikizumab, abatacept.
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Affiliation(s)
- Lucia Brambilla
- Dermatology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Enrico Zelin
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Giovanni Genovese
- Dermatology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Athanasia Tourlaki
- Dermatology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Sahin O, Albayrak M, Yıldız A, Pala Ç, Aktas L, Maral S, Afacan Öztürk HB, Cömert P. Refractory Thrombotic Thrombocytopenic Purpura in a patient with Kaposi sarcoma. Transfus Apher Sci 2019; 58:187-189. [PMID: 30910619 DOI: 10.1016/j.transci.2019.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/21/2019] [Accepted: 02/21/2019] [Indexed: 10/27/2022]
Abstract
The case is here presented of a 70-year old male patient with rare coexistence of Kaposi Sarcoma and resistant Thrombotic Thrombocytopenic Purpura (TTP). The Kaposi lesions were determined before the diagnosis of TTP and were exacerbated after receiving TTP-associated immunosuppressive therapy, in particular associated with rituximab. TTP in this case was resistant to conventional therapies such as steroid and plasma exchange and current immunosuppressive (rituximab, cyclophosphamide, vincristin) treatments. Novel treatment agents consisting of bortezomib and eculizumab given to the patient were also ineffective. To the best of our knowledge, this case presents the first case of coexistence of TTP and Kaposi sarcoma from Turkey and the challenge of refractory TTP management.
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Affiliation(s)
- Osman Sahin
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Hematology, Ankara, Turkey.
| | - Murat Albayrak
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Hematology, Ankara, Turkey
| | - Abdulkerim Yıldız
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Hematology, Ankara, Turkey
| | - Çiğdem Pala
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Hematology, Ankara, Turkey
| | - Levent Aktas
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Hematology, Ankara, Turkey
| | - Senem Maral
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Hematology, Ankara, Turkey
| | - Hacer Berna Afacan Öztürk
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Hematology, Ankara, Turkey
| | - Pınar Cömert
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Hematology, Ankara, Turkey
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Geller S, Dickson MA, Busam KJ, Myskowski PL. Kaposi's Sarcoma After Autologous Stem-Cell Transplantation and Rituximab Treatment. J Oncol Pract 2018; 14:565-568. [PMID: 30044684 DOI: 10.1200/jop.18.00246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Shamir Geller
- Memorial Sloan Kettering Cancer Center; and Weill Cornell Medical College, New York, NY
| | - Mark A Dickson
- Memorial Sloan Kettering Cancer Center; and Weill Cornell Medical College, New York, NY
| | - Klaus J Busam
- Memorial Sloan Kettering Cancer Center; and Weill Cornell Medical College, New York, NY
| | - Patricia L Myskowski
- Memorial Sloan Kettering Cancer Center; and Weill Cornell Medical College, New York, NY
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Billon E, Stoppa AM, Mescam L, Bocci M, Monneur A, Perrot D, Bertucci F. Reversible rituximab-induced rectal Kaposi's sarcoma misdiagnosed as ulcerative colitis in a patient with HIV-negative follicular lymphoma. Clin Sarcoma Res 2018; 8:11. [PMID: 29992013 PMCID: PMC5994652 DOI: 10.1186/s13569-018-0097-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 03/13/2018] [Indexed: 01/08/2023] Open
Abstract
Background Kaposi’s sarcoma is a low-grade mesenchymal angioproliferative tumor, most commonly observed in immunocompromised individuals, such as HIV-infected patients. Iatrogenic Kaposi’s sarcoma occurs in patients undergoing immunosuppressive therapies. Rituximab is a chimeric monoclonal antibody targeted against the pan B cell marker CD20. Because of its immunosuppressive effects through reduction of mature B-cells, it may exacerbate Kaposi’s sarcoma in HIV-positive patients. Rituximab-related Kaposi’s sarcomas have been previously reported in only two HIV-negative patients and were treated surgically. Case presentation Here, we report on a Kaposi’s sarcoma that developed under rituximab treatment in a HIV-negative 55-year-old patient treated for follicular lymphoma. The lesion developed during the maintenance rituximab therapy at the rectal level with an aspect of apparent ulcerative colitis, without any cutaneous lesion. The premature stop of rituximab led to the complete regression of Kaposi’s sarcoma, without any additional specific treatment. Conclusions To our knowledge, this is the third case of Kaposi’s sarcoma diagnosed under rituximab in a HIV-negative patient, the first one at the rectal level and the first one that completely regresses after stop of rituximab. This case raises awareness of iatrogenic Kaposi’s sarcoma in HIV-negative patients treated with rituximab, and further highlights the importance of immunosuppression in the pathophysiology of disease.
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Affiliation(s)
- Emilien Billon
- 1INSERM UMR1068, CNRS UMR725, Department of Medical Oncology, Centre de Recherche en Cancérologie de Marseille (CRCM), Institut Paoli-Calmettes, 232 Bd de Sainte-Marguerite, 13009 Marseille, France
| | - Anne-Marie Stoppa
- 2Department of Hematology, Institut Paoli-Calmettes, Marseille, France
| | - Lena Mescam
- 3Department of Pathology, Institut Paoli-Calmettes, Marseille, France
| | - Massimo Bocci
- 4Department of Digestive Endoscopy Centre Hospitalier Edmond Garcin, Aubagne, France
| | - Audrey Monneur
- 1INSERM UMR1068, CNRS UMR725, Department of Medical Oncology, Centre de Recherche en Cancérologie de Marseille (CRCM), Institut Paoli-Calmettes, 232 Bd de Sainte-Marguerite, 13009 Marseille, France
| | - Delphine Perrot
- 1INSERM UMR1068, CNRS UMR725, Department of Medical Oncology, Centre de Recherche en Cancérologie de Marseille (CRCM), Institut Paoli-Calmettes, 232 Bd de Sainte-Marguerite, 13009 Marseille, France.,French Sarcoma Group, Paris, France
| | - François Bertucci
- 1INSERM UMR1068, CNRS UMR725, Department of Medical Oncology, Centre de Recherche en Cancérologie de Marseille (CRCM), Institut Paoli-Calmettes, 232 Bd de Sainte-Marguerite, 13009 Marseille, France.,5Faculty of Medicine, Aix-Marseille University, Marseille, France.,French Sarcoma Group, Paris, France
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Brambilla L, Tourlaki A, Genovese G. Iatrogenic Kaposi's Sarcoma: a Retrospective Cohort Study in an Italian Tertiary Care Centre. Clin Oncol (R Coll Radiol) 2017; 29:e165-e171. [PMID: 28610760 DOI: 10.1016/j.clon.2017.05.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/04/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
Abstract
AIMS Kaposi's sarcoma (KS) is a lymphoangioproliferative multicentric disorder. Among its four distinct clinical variants, iatrogenic KS (iKS) typically affects patients who have received immunosuppressant regimens for organ transplants, proliferative disorders, or immune-mediated diseases. The aim of the current study was to examine the characteristics of a cohort of patients with iKS, evaluating the differences in terms of epidemiological and clinical features, management and outcomes between organ transplant recipients (OTR) and patients immunosuppressed for other medical conditions. MATERIALS AND METHODS This retrospective study included, out of 1389 KS patients, 143 patients suffering from iKS being followed in an Italian tertiary care centre from November 1995 to December 2016. Demographic data, clinical features, previous immunosuppressive therapies, management, and outcomes were recorded for each patient. RESULTS We detected iKS in 10.3% of the analysed KS population. The mean age was 71.9 years in non-OTR versus 51.4 years in OTR (P = 0.04). Staging at diagnosis showed a more severe disease in non-OTR than in OTR, with stage IA observed in 33.3% of OTR versus 11.8% of non-OTR (P < 0.001) and stage IVB in 29.1% of non-OTR versus 12.1% of OTR (P = 0.001). Corticosteroids represented the most frequent immunosuppressive drugs at diagnosis in both groups, in conjunction with cyclosporine A in OTR. Immunosuppressant reduction or withdrawal was carried out in 93.9% of OTR versus 63.6% of non-OTR (P < 0.001). CONCLUSIONS As corticosteroids and cyclosporine A are the most common iKS-inducing drugs, their reduction or withdrawal, wherever possible, is needed. Differences in disease severity at presentation between OTR and non-OTR may interfere with the choice of management strategy and the consequent outcome.
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Affiliation(s)
- L Brambilla
- Unit of Dermatology, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Tourlaki
- Unit of Dermatology, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - G Genovese
- Unit of Dermatology, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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