KSHV INFLAMMATORY CYTOKINE SYNDROME (KICS) S. Sridhar MD1, V. Silver DO2, T. Davidge MD1, N Patel MD 3 1 Department of Internal Medicine, LSU Health, New Orleans, LA 2 Department of Emergency Medicine-Internal Medicine, LSU Health, New Orleans, LA 3 Section of Infectious Diseases and Pulmonary Critical Care, University Medical Center in New Orleans, New Orleans, LA
INTRODUCTION: KICS is a newly-described complication of Kaposi sarcoma-associated herpesvirus (KSHV) infections that is poorly described due to its high mortality rate. Most available data on KICS is derived from case reports.
CASE: A 33-year-old man with newly diagnosed HIV (CD4 332 cells/mm3), recent renal failure, thrombocytopenia, ocular syphilis, and Kaposi sarcoma presented with progressive dyspnea, productive cough, and pleuritic chest pain. On initial evaluation, the patient was tachypneic, tachycardic, and hypotensive. He had coarse crackles with poor air movement. Violaceous oral lesions were noted on the hard palate along with cervical and axillary lymphadenopathy. Several violaceous lesions covered the patient’s arms. He was admitted to the MICU for continuous BiPAP but he quickly decompensated and was intubated a few hours later. The next day, his abdomen became distended in the setting of poor urine output. Bedside ultrasound showed abdominal fluid and a right pleural effusion. A chest tube was placed that drained serosanguinous fluid. He became hypotensive and did not improve with vasopressors. The etiology of patient’s condition was through to be from inflammatory cytokine syndrome secondary to Kaposi sarcoma, but the patient was too unstable to tolerate chemotherapy with doxorubicin and rituximab. He remained anuric and CRRT was initiated and then discontinued on day 4 as the patient was persistently hypotensive despite maximal therapy. With the patient’s progressing multiorgan failure, his family chose to pursue comfort care. A cytokine panel, that had been sent out to an outside lab, demonstrated elevated IL-2, IL-2R, interferon gamma, IL-10, IL-13, and IL-6, which supports KSHV Inflammatory Cytokine Syndrome (KICS) as the etiology of the patient’s presentation. Although, KICS was suspected early, the disease process progressed too quickly for treatment to have been initiated. DISCUSSION: KICS typically presents in patients with a low CD4 count even if the patient is being treated with ART. Clinical presentation often resembles sepsis, but these patients will not respond to antibiotic therapy. Mortality rate is 60% with better outcomes in cases with early diagnosis and chemotherapy.
10
Made with FlippingBook Digital Publishing Software