A 31 year old African-American male, with a history of HIV, non-compliant with medications, presents with 3 months of painful “balls and bumps” on his left thigh. He was evaluated at another hospital prior to this visit and was discharged with 7 days of TMP-SMX. He denies any fever, chills, weight loss, night sweats, or anorexia.
Vitals: Temp: 36.6C, HR 79, BP 123/75, RR 18, SpO2: 99%
General: Well appearing
Skin: Left medial thigh has multiple red and violaceous nodules with additional plaques coalescing into larger tumors; pitting edema from groin to calf.
WBC: 2.4 K/mcL
Imaging X-ray: Several well circumscribed soft tissue lesions
CT Left Lower Extremity: Enhancing, high attenuating, polypoid lesions
- Bacillary angiomatosis
- Kaposi sarcoma
Diagnosis can be determined via biopsy of the lesion.
Kaposi Sarcoma (KS) is a malignancy of vascular endothelial cells first described by Moritz Kaposi in 1872. More recently, it is the most common tumor associated with HIV/AIDS. The widespread use of antiretroviral therapy has decreased the incidence of KS in the United States significantly; however, emergency physicians still need to recognize and manage KS.
Clinically, cutaneous KS most often appears on the lower extremities, face, oral mucosa, and genitalia in an assortment of shapes, sizes, and colors.
Bacillary angiomatosis (caused by Bartonella henselae/quintana) may be clinically indistinguishable from KS in immunocompromised patients as it presents similarly with a variety of cutaneous lesions. Biopsy is needed to differentiate.
Take Home Points
- Have a high suspicion for KS in immunocompromised individuals.
- Diagnose KS with a biopsy.
- The primary treatment of KS is strengthening the immune system with highly active antiretroviral therapy (HAART).