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LETTER TO EDITOR
Year : 1996  |  Volume : 62  |  Issue : 2  |  Page : 129-131

Aids related kaposi's sarcoma - Like lesion




Correspondence Address:
A K Agarwal


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Source of Support: None, Conflict of Interest: None


PMID: 20948008

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How to cite this article:
Agarwal A K, Zamzachin G, Singh MY, Singh N. Aids related kaposi's sarcoma - Like lesion. Indian J Dermatol Venereol Leprol 1996;62:129-31

How to cite this URL:
Agarwal A K, Zamzachin G, Singh MY, Singh N. Aids related kaposi's sarcoma - Like lesion. Indian J Dermatol Venereol Leprol [serial online] 1996 [cited 2019 Jun 17];62:129-31. Available from: http://www.ijdvl.com/text.asp?1996/62/2/129/4347



  To the Editor, Top


Kaposi's sarcoma (KS) is the commonest neoplasm in persons infected with HIV. India has the largest number (68%) of HIV infected individuals among the countries of South-East Asia. The major mode of transmission of HIV in India is through sex (75%)[1] but in Manipur the major route is through injection (52%).[2] HIV associated KS is thought to be rare in this part of the World but this may not remain so in future. No proved case of KS has been reported so far from Manipur.

We have suspected a 22-year-old male suffering from AIDS related KS. The patient presented with occasional cough, haemoptysis, fever, loss of appetite and darkening of complexion for approximately 6 months. Macules and papules started to appear 2 months later in the trunk and gradually became generalized. They were reddish in colour to start with and later became dark brown, there was no associated pain or itching. There was also a history of difficulty in swallowing food for 1 month. He slowly became weaker and bedridden, the loss of body weight was more than 10%.

The patient was an injecting drug user for approximately 5 years since 1987 Sharing of the unclean needle and syringe with partners was present. There was no history of sexual experience. The person was unmarried. He did not have a history of any sexually transmitted disease (STD). He was treated in the past by several courses of antibiotics and vitamins but to no avail.

On examination, the patient was pale, wasted, generalized lymphadenopathy and skin lesions were present. Oropharyngeal candidiasis was also noted. No abnormality was detected in the respiratory, lower gastrointestinal tract, cardiovascular, genito-urinary and central nervous systems. The skin lesions were papulonodular, dark reddish in colour and did not blanch on pressure, the density of the lesions was maximum in the front and back of the trunk.

Investigations : haemogram normal except haemoglobin 10.2 gm%, ESR 105 mm in 1st hour, Mantoux test 0 mm after 48 hours, sputum for acid fast bacilli negative, chest X-ray normal, antibody against HIV positive (by ELISA and Western Blot Method). Histopathological examination of a skin nodule revealed no definite evidence of Kaposi's sarcoma (mild acanthosis and papillomatosis with hyperkeratosis was noted, the upper epidermis showed few vascular channels with a sprinkling of round cell infiltrate).

Kaposi's sarcoma is a multifocal endothelial cell-derived tumour which primarily affects the skin but may involve other tissues as well. [3,4] It is often the presenting clinical manifestation of AIDS. HIV is not the direct cause of Kaposi's sarcoma and there is no evidence of malignant transformation of cells. The course of Kaposi's sarcoma ranges from indolent, with only skin manifestations to fulminant with extensive visceral involvement. Although any organ system can be involved in the disseminated form, lymph nodes, gastrointestinal tract and lungs are most commonly involved. The skin lesions generally present as papules or plaques that ultimately evolve into nodules. Lesions can occur at any location, but the face is a common site, specially the tip of the nose and pinnae of the ears.

Histologically, slit-like spaces lined by flattened cells supported by groups of spindle cells which are admixed with red cells and haemosiderin are characteristic. A diagnostic though rare feature is the presence of eosinophilic globules in the cytoplasm of spindle cells.[5]

A variety of skin conditions may be considered as differential diagnosis in this case. Fixed drug eruption presents with erythematous or hyperpigmented macules and sometimes bullae but papules and nodules are not the features. Papules, nodules and plaques may all be present in lichen planus but the lesions are intensely itchy. Lichen prurigo and prurigo nodularis are again irritable hypertrophic papules and nodules. Lichen simplex chronicus are usually lichenified plaques at typical sites. Multiple neurofibromatosis lesions are soft skin coloured nodules. Nodules and tumours are also seen in mycosis fungoides and Hodgkin's disease but they show characteristic histological features. Cutaneous mycobacterial infections have typical clinical and histological features.

In view of the frequent association of AIDS with Kaposi's sarcoma, Kaposi's sarcoma like lesion may be considered clinically in this HIV positive patient though the characteristic histological features could not be obtained in this case. The papules and nodules in present case did not fit at least clinically into any of the other skin diseases.

 
  References Top

1.National AIDS control programme, India-Report, Sept. 1994.  Back to cited text no. 1    
2.Epidemiological Analysis of HIV/AIDS in Manipur, Medical Directorate Report, Oct. 1995.  Back to cited text no. 2    
3.Rutherford GW, Schwarcz SK, Lemp GF, et al. The epidemiology of AIDS related Kaposi's sarcoma in San Francisco. J Infect Dis 1989, 159:569-71.  Back to cited text no. 3  [PUBMED]  
4.Chachoua A, Kriqel R, Lafleur F, et al. Prognostic factors and staging classifications of patients with epidemic Kaposi's sarcoma. J Chin Oncol 1989;7:774-80.  Back to cited text no. 4    
5.Francis ND, Parkin JM, Weber J, et al. Kaposi's sarcoma in acquired immunodeficiency syndrome (AIDS). J Clin Pathol 1986;39:469-74.  Back to cited text no. 5    




 

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