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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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Magri F, Giordano S, Latini A, Muscianese M. New-onset cutaneous kaposi's sarcoma following SARS-CoV-2 infection. J Cosmet Dermatol 2021; 20:3747-3750. [PMID: 34731523 PMCID: PMC8661758 DOI: 10.1111/jocd.14549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND COVID-19 is associated with several cutaneous manifestations, including chilbain-like lesions, urticaria, erythema multiforme, and maculopapular lesions. Dermatoses may be directly linked to the viral infection or also represent a consequence of systemic therapies administrated for COVID-19. A potential role of SARS-CoV-2 in triggering the reactivation of other viruses, such as HHV-6, HHV-7 and Epstein-Barr virus has been hypothesized. OBJECTIVE To better understand and hypothesize possible pathogenetic correlations of COVID-19 with other dermatological conditions. METHODS We report the case of an 83-year-old woman hospitalized in a nursing home for several years. On November 2020, the patient had been diagnosed with SARS-CoV-2 infection, with repeated positive swabs until January 2021. After a month, new-onset asymptomatic cutaneous purplish macular lesions and violaceous patches occurred bilaterally on the feet. RESULTS An incisional cutaneous biopsy and the histological examination of the plantar lesion revealed the diagnosis of Kaposi Sarcoma. CONCLUSION We report a unique case of new-onset bilateral Kaposi's sarcoma following COVID-19, speculating on a possible role of SARS-CoV-2 in the reactivation of human herpes virus-8 (HHV-8) infection.
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Affiliation(s)
| | | | - Alessandra Latini
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
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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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Iatrogenic Kaposi's sarcoma in myasthenia gravis: learnings from two case reports. Neurol Sci 2021; 42:2081-2083. [PMID: 33404862 PMCID: PMC8043948 DOI: 10.1007/s10072-020-04971-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/05/2020] [Indexed: 11/06/2022]
Abstract
Introduction Myasthenia gravis (MG) is an autoimmune neuromuscular disease whose treatment encompasses acetylcholinesterase inhibitors, oral steroids, and other immunosuppressants. Kaposi’s sarcoma (KS) is a lymphangioproliferative disease associated with human herpesvirus 8 (HHV-8) infection and immunodeficiency or immunosuppression, mainly corticosteroids. Case reports We present two cases of MG patients treated with oral steroids who developed KS. Patient 1 was diagnosed with three oral KS lesions. Prednisone was discontinued with lesion regression and stabilization, while azathioprine and pyridostigmine prompted control of MG. Patient 2 developed KS lesions on the trunk and lower limbs while taking prednisone and azathioprine. Steroid tapering was started but new oral and lymph nodal lesions appeared. Paclitaxel therapy was introduced and the patient experienced pulmonary embolism and developed sensitive neuropathy. Complete remission of KS lesions was achieved and maintained with azathioprine and pyridostigmine as MG medications. Conclusions KS is an uncommon but clinically relevant adverse event (AE) often induced by steroid therapy. It can be controlled by steroid withdrawal but could necessitate chemotherapy, which associates with further potential AEs. Skin evaluation should be performed in all patients with chronic steroid therapy. Steroid-sparing strategies, including new drugs, could reduce KS and other steroid-related comorbidities. HHV-8 testing should be considered before starting chronic immunosuppression.
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Cahoon EK, Linet MS, Clarke CA, Pawlish KS, Engels EA, Pfeiffer RM. Risk of Kaposi sarcoma after solid organ transplantation in the United States. Int J Cancer 2018; 143:2741-2748. [PMID: 29987894 PMCID: PMC10655926 DOI: 10.1002/ijc.31735] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/31/2018] [Accepted: 06/13/2018] [Indexed: 11/19/2023]
Abstract
Due to treatment with immunosuppressive medications, solid organ transplant recipients have elevated risk for Kaposi sarcoma (KS), which is caused by human herpesvirus 8 (HHV8). Other risk factors for KS are poorly understood. We linked the United States solid organ transplant registry with 17 population-based cancer registries to ascertain KS incidence among 244,964 transplant recipients from 1987-2014. To compare incidence rates of KS according to patient and transplant characteristics, we calculated incidence rate ratios (IRRs) using Poisson regression. To compare associations of KS with other skin cancers occurring before or within 12 months of KS diagnosis, we computed odds ratios (ORs) and 95% confidence intervals (CIs) using conditional logistic regression. All statistical tests were two-sided. We identified 163 KS cases during follow-up. Among transplant recipients, we found significantly increased risk of KS associated with male sex (IRR = 1.87; 95%CI:1.32,2.71), nonwhite race (IRR = 2.67; 95%CI:1.92,3.72), non-US citizenship (IRR = 2.10; 95%CI:1.19,3.47), lung transplant (IRR = 2.22; 95%CI:1.03,4.24, vs. kidney), and older age at transplant. KS risk decreased significantly with time since transplant and recent calendar year, however, no specific induction or maintenance medication was associated with KS. KS incidence was not significantly associated with ambient ultraviolet radiation (IRR = 1.32 95%CI:0.87,2.02, tertile 3 vs. 1). KS incidence has decreased in recent calendar years. In a cross-sectional sample, we found cutaneous squamous cell carcinoma was associated with KS (OR = 4.83; 95%CI:1.30,14.69). KS risk factors included those potentially associated with HHV8 infection and increased immunosuppression. Our findings suggest that transplant recipients with a non-KS skin cancer may also be at high KS risk.
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Affiliation(s)
- Elizabeth K Cahoon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Martha S Linet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Christina A Clarke
- Cancer Prevention Institute of California, Fremont, CA; Department of Health Research and Policy and the Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA
| | - Karen S Pawlish
- New Jersey Department of Health, Cancer Epidemiology Services, Trenton, New Jersey
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Ulger S, Kizilarslanoglu M, Gokce D, Kilic M, Yildiz R, Aksakal A, Gocun P, Ulger Z. Kaposi's sarcoma in a geriatric patient following low-dose steroid therapy for polymyalgia rheumatica. Eur Geriatr Med 2015. [DOI: 10.1016/j.eurger.2014.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Taniguchi T, Asano Y, Kawaguchi M, Kogure A, Mitsui H, Sugaya M, Sato S. Disseminated cutaneous and visceral Kaposi’s sarcoma in a patient with rheumatoid arthritis receiving corticosteroids and tacrolimus. Mod Rheumatol 2014. [DOI: 10.3109/s10165-010-0389-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Takashi Taniguchi
- Department of Dermatology, Faculty of Medicine, University of Tokyo,
7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yoshihide Asano
- Department of Dermatology, Faculty of Medicine, University of Tokyo,
7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Makiko Kawaguchi
- Department of Dermatology, Faculty of Medicine, University of Tokyo,
7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Asako Kogure
- Department of Dermatology, Faculty of Medicine, University of Tokyo,
7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hiroshi Mitsui
- Department of Dermatology, Faculty of Medicine, University of Tokyo,
7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Makoto Sugaya
- Department of Dermatology, Faculty of Medicine, University of Tokyo,
7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Shinichi Sato
- Department of Dermatology, Faculty of Medicine, University of Tokyo,
7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Effets indésirables cutanés des glucocorticoïdes. Rev Med Interne 2013; 34:310-4. [DOI: 10.1016/j.revmed.2012.12.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 12/10/2012] [Indexed: 11/21/2022]
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Kaposi sarcoma: review and medical management update. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:2-16. [DOI: 10.1016/j.tripleo.2011.05.011] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 05/11/2011] [Accepted: 05/15/2011] [Indexed: 12/21/2022]
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Disseminated cutaneous and visceral Kaposi's sarcoma in a patient with rheumatoid arthritis receiving corticosteroids and tacrolimus. Mod Rheumatol 2010; 21:309-12. [PMID: 21188451 DOI: 10.1007/s10165-010-0389-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 11/14/2010] [Indexed: 10/18/2022]
Abstract
Kaposi's sarcoma (KS) is a vascular lesion of low-grade malignant potential caused by the complex interactions between geographic, genetic, environmental, and immunological factors. We recently experienced a rare case of KS associated with rheumatoid arthritis in a patient receiving corticosteroids and tacrolimus; the KS demonstrated unusually aggressive clinical behavior. We herein report the details of the clinical course and discuss the possible contribution of corticosteroids and tacrolimus to the development of aggressive KS in the present case.
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Choi KH, Byun JH, Lee JY, Cho BK, Park HJ. Kaposi sarcoma after corticosteroid therapy for idiopathic thrombocytopenic purpura. Ann Dermatol 2010; 21:297-9. [PMID: 20523809 DOI: 10.5021/ad.2009.21.3.297] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 01/29/2009] [Indexed: 11/08/2022] Open
Abstract
Kaposi sarcoma (KS) is a multifocal vascular neoplasm most commonly seen in association with human immunodeficiency virus infection. However, KS has also been reported in patients treated with immunosuppressive agents. However, it is very rare to find KS in association with idiopathic thrombocytopenic purpura (ITP). Here we describe a 58-year-old male patient suffering from ITP treated with corticosteroid therapy who developed KS and present a review of the literature.
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Affiliation(s)
- Kwang Hyun Choi
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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12
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Disseminated cutaneous and visceral Kaposi sarcoma in a woman with rheumatoid arthritis receiving leflunomide. Rheumatol Int 2010; 32:1065-8. [DOI: 10.1007/s00296-009-1354-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 12/29/2009] [Indexed: 11/25/2022]
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Miranda JA, Fernández JC, Monteagudo B, Barbazán C. [Not Available]. REUMATOLOGIA CLINICA 2005; 1:134. [PMID: 21794250 DOI: 10.1016/s1699-258x(05)72728-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- J A Miranda
- Servicio de Reumatología. Hospital Xeral-Cíes. Vigo. Pontevedra. España
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Louthrenoo W, Kasitanon N, Mahanuphab P, Bhoopat L, Thongprasert S. Kaposi's sarcoma in rheumatic diseases. Semin Arthritis Rheum 2003. [DOI: 10.1053/sarh.2002.59000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Burnet SP, McNeil JD. Kaposi's sarcoma in an elderly patient with rheumatoid arthritis after intra-articular corticosteroids. Rheumatology (Oxford) 2002; 41:107-8. [PMID: 11792889 DOI: 10.1093/rheumatology/41.1.107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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