Journal of the Louisiana State Medical Society
for oropharyngeal Kaposi sarcoma (KS). The infectious disease consultants recommended use of liposomal amphotericin for the treatment of Paecilomyces infection, as well as a biopsy of the hard palate lesion. Oral prednisone was continued due to concerns for ongoing IRIS. The biopsy revealed proliferation of atypical spindle cells forming fascicles, bundles, and cleft-like structures lined by mildly atypical endothelial cells. Red cells were noted between the spindle cells and vascular lumina (Figure 3). Immuno- histochemical stains for human herpesvirus-8 (HHV-8), CD31, CD34, and Factor VII were strongly positive, supporting the diagnosis of KS (Figure 4). Oncologywas consulted and recommended bronchoscopy and colonoscopy for staging. Bronchoscopy revealed several new, violaceous, submucosal endobronchial lesions suggestive of KS. The lesions were not biopsied due to concern for bleeding. Gramstain performed on BAL fluid revealed a few yeast colonies which did not grow in culture. Routine cultures for bacteria and acid-fast bacilli were negative. Colonoscopy revealed a rectal lesion suggestive of KS, further confirming the disseminated nature of the illness in this patient. Because of the concern for his concomitant fungal pneumonia, chemotherapy was held until his pneumonia had improved. After an 18-day hospital stay, he was discharged home. Steroids were tapered off, liposomal ampho- tericin was discontinued, and voriconazole was initiated with a minimum of six additional months of antifungal therapy planned. At the time of hospital discharge, his productive cough had ceased, and he was no longer requiring supplemental oxygen. On outpatient follow-up, he continued to improve. Repeat CT scan of the chest eight weeks following discharge showed improvement in the basilar consolidations and decreased size of several of the nodular lesions (Figure 5). KS EPIDEMIOLOGY Prior to 1981, the estimated annual inci- dence of KS in the United States was between 0.02 and 0.06 cases per 100,000. 1,2 In June 1981, numerous case reports of KS began to surface in large metropolitan areas of New York and California. 2-4 In contrast to previous cases, these patients were typically young men (39 years old on average) who were homosexual or bisexual. 2 In addition, these tumors behavedmore aggres- sively. These cases led to the establishment of the Task Force on KS and Opportunistic Infec-
Figure 4: (HHV-8 immunostain 100x) Low-power image of atypical spindle cells in fascicles showing strong nuclear immunostaining for HHV-8.
Figure 5: Follow-up CT of the chest showing improvement in the basilar consolidations and decreased size of several of the nodular lesions.
226 J La State Med Soc VOL 166 September/October 2014
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