Case Report

Osseous Metastases in HIV Patient with Kaposi Sarcoma

by Sophie Y. Lin*, Oguchi Andrew Nwosu

Department of Family Medicine, Emory University School of Medicine, Atlanta, Georgia.

*Corresponding author: Sophie Y Lin, Department of Family Medicine, Emory University School of Medicine, Atlanta, Georgia.

Received Date: 13 December 2023

Accepted Date: 18 December 2023

Published Date: 20 December 2023

Citation: Lin SY, Nwosu AO (2023) Osseous Metastases in HIV Patient with Kaposi Sarcoma. Ann Case Report 8: 1557. https://doi.org/10.29011/2574-7754.101557

Abstract

Osseous lesions in AIDS-related Kaposi sarcoma (KS) are extremely rare, with approximately 30 published cases to date. We highlight a case of a HIV-positive patient who was initially misdiagnosed with cellulitis but later found to have KS with osseous metastases and concomitant osteomyelitis. MRI was necessary to detail unique features and confirm both pathologies. However, biopsy of a lesion is still the gold standard for definitive diagnosis of KS and can be confirmed with immunohistochemistry for LANA1. The mainstay of treatment is a tailored combination of ART, chemotherapy, local radiation therapy, and surgery. Given that osseous KS is rare and often confounded with other musculoskeletal pathology, education is critical for proper and timely treatment. Our case report provides trainees and physicians with clinical, radiographic, and histopathologic images to aid in the diagnosis and management of osseous KS.

Keywords: Kaposi Sarcoma; Osseous Metastases; HIV; HHV8

Introduction

Kaposi sarcoma (KS) is an angioproliferative neoplasm commonly associated with human herpesvirus 8 (HHV8) and HIV/ AIDS. It often presents as violaceous pink to purple plaques on the skin or mucocutaneous surfaces with localized lymphedema. Osseous lesions in AIDS-related KS are extremely rare, with approximately 30 published cases to date [1]. Patients often present with bone pain and have osseous KS lesions in the axial and/or maxillofacial skeleton [1]. We highlight a case of a HIV-positive patient who was found to have KS with osseous metastases and concomitant osteomyelitis.

Case Report

A 40-year-old Black man with HIV presented with three months of left lower extremity swelling, pain, and worsening rash. He had been inconsistently taking his antiretroviral therapy (ART) due to financial difficulties and was treated at an outside hospital around 3 weeks prior for suspected cellulitis. He reported improvement in the leg swelling during that hospitalization, but the swelling recurred upon discharge due to inability to afford his antibiotics. He also reported a history of intermittent melena and rectal bleeding. No fevers, night sweats, or unintentional weight loss.

On admission, he was afebrile with a normal white blood cell count (WBC), CD4 201 (12.5%), and viral load 671 copies/mL. His exam was positive for small 1-2 mm red-purple papules on his hard palate (Figure 1a), axillary and inguinal lymphadenopathy, violaceous nodules and plaques with substantial lymphedema of his left thigh (Figure 1b), and blistering of his left third toe with tenderness to palpation at the base. Initial CT of his left lower extremity demonstrated soft tissue swelling and erosive osseous changes in his second and third toes as well as multiple new scattered lytic lesions in the lower spine and pelvis. Subsequent MRI of his lumbar spine (Figure 2a) and pelvis (Figure 2b) redemonstrated numerous enhancing osseous lesions throughout his lumbar spine, partially visualized thoracic spine, and pelvis. MRI of his left foot also confirmed acute osteomyelitis of his second through fifth distal and middle phalanges.