Spinal Kaposi sarcoma presenting without cutaneous manifestations. Case report

Disseminated AIDS-associated Kaposi sarcoma without cutaneous involvement: a case report and review of literature

Disseminated AIDS-associated Kaposi sarcoma (KS) without cutaneous lesions is rare and can present in varying ways. Diagnosis is even more challenging now when incidence of KS is on the decline. A high index of suspicion is required for early diagnosis and treatment. Therefore, the medical literature should be made aware of any manifestations of KS that can occur without the typical cutaneous lesions. A 23-year-old presented with worsening cervical lymphadenopathy, recurrent cough and bilateral leg swelling of a month duration. Examination revealed features of pericardial effusion, pulmonary fibrosis, necrotizing cervical lymphadenopathy and the presence of pityriasis rotunda at the periumbilical region. Patient was diagnosed human immunodeficiency virus (HIV) positive 6 months before she presented and was placed on antiretroviral therapy. Histology confirmed AIDS-associated KS. However, patient died before commencement of chemotherapy. The clinical course of disseminated AIDS-associated KS without cutaneous lesions can be atypical and aggressive. It is important to include KS in the differential diagnosis of cases with atypical or persistence/recurrence of clinical symptoms in spite of treatment especially in HIV patients.

Primary intraosseous Kaposi's sarcoma of the maxilla in AIDS: a case report

In China, Kaposi's sarcoma (KS) is very rare. However, KS does occur as one of the complications in patients with acquired immunodeficiency syndrome (AIDS). Usually AIDS-related KS involves the lymph nodes, the skin and gastrointestinal tract. Intraosseous KS have been reported but it is very rare. We report a case of primary intraosseous KS of the maxilla in an AIDS patient, proven by pathology findings and showed multiple metastasis by positron emission tomography and computed tomography (PET/CT). To our knowledge, this is the first report of primary intraosseous KS of the maxilla in an AIDS patient in China.

A man with oral lesions, constipation and back pain

We describe an unusual presentation of disseminated Kaposi sarcoma in a 49-year-old African-American man with AIDS who was admitted to the hospital for constipation and back pain. Magnetic resonance imagings of the thoracic and lumbar spine were grossly abnormal, however, a biopsy of the iliac crest was interpreted as normal. The patient remained a diagnostic enigma until disseminated Kaposi sarcoma was suspected, based on vascular plaque-like lesions observed on his hard palate and right conjunctiva. Slides of the bone biopsy with were stained for human herpes virus-8 (HHV-8) antigen, and were positive. AIDS-related skeletal manifestations of Kaposi sarcoma have been reported in the literature but are infrequent.

Disparities in rates of spine surgery for degenerative spine disease between HIV-infected and uninfected veterans

STUDY DESIGN

Retrospective analysis of nationwide Veterans Health Administration clinical and administrative data.

OBJECTIVE

Examine the association between HIV infection and the rate of spine surgery for degenerative spine disease.

SUMMARY OF BACKGROUND DATA

Combination antiretroviral therapy has prolonged survival in HIV-infected patients, increasing the prevalence of chronic conditions such as degenerative spine disease that may require spine surgery.

METHODS

We studied all HIV-infected patients under care in the Veterans Health Administration from 1996 to 2008 (n = 40,038) and uninfected comparator patients (n = 79,039) matched on age, sex, race, year, and geographic region. The primary outcome was spine surgery for degenerative spine disease, defined by International Classification of Diseases, Ninth Revision procedure and diagnosis codes. We used a multivariate Poisson regression to model spine surgery rates by HIV infection status, adjusting for factors that might affect suitability for surgery (demographics, year, comorbidities, body mass index, combination antiretroviral therapy, and laboratory values).

RESULTS

Two hundred twenty-eight HIV-infected and 784 uninfected patients underwent spine surgery for degenerative spine disease during 700,731 patient-years of follow-up (1.44 surgeries per 1000 patient-years). The most common procedures were spinal decompression (50%) and decompression and fusion (33%); the most common surgical sites were the lumbosacral (50%) and cervical (40%) spine. Adjusted rates of surgery were lower for HIV-infected patients (0.86 per 1000 patient-years of follow-up) than for uninfected patients (1.41 per 1000 patient-years; incidence rate ratio 0.61, 95% confidence interval: 0.51-0.74, P < 0.001). Among HIV-infected patients, there was a trend toward lower rates of spine surgery in patients with detectable viral load levels (incidence rate ratio 0.76, 95% confidence interval: 0.55-1.05, P = 0.099).

CONCLUSION

In the Veterans Health Administration, HIV-infected patients experience significantly reduced rates of surgery for degenerative spine disease. Possible explanations include disease prevalence, emphasis on treatment of nonspine HIV-related symptoms, surgical referral patterns, impact of HIV on surgery risk-benefit ratio, patient preferences, and surgeon bias.

Kaposi sarcoma in unusual locations

Kaposi sarcoma (KS) is a multifocal, vascular lesion of low-grade malignant potential that presents most frequently in mucocutaneous sites. KS also commonly involves lymph nodes and visceral organs. This article deals with the manifestation of KS in unusual anatomic regions. Unusual locations of KS involvement include the musculoskeletal system, central and peripheral nervous system, larynx, eye, major salivary glands, endocrine organs, heart, thoracic duct, urinary system and breast. The development of KS within wounds and blood clots is also presented. KS in these atypical sites may prove difficult to diagnose, resulting in patient mismanagement. Theories to explain the rarity and development of KS in these unusual sites are discussed.