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Pulmonary Kaposi Sarcoma Mimicking Pneumonia in Heterosexual HIV Female- A Rare Presentation
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A4055 - Pulmonary Kaposi Sarcoma Mimicking Pneumonia in Heterosexual HIV Female- A Rare Presentation
Author Block: B. Bhattarai1, J. Lamichhane2, O. Abdulfattah1, P. B. Datar1, A. Lixon1, M. Hossain3, S. Dahal3, J. B. K. Quist1, D. Enriquez1, M. Schmidt1; 1Pulmonary Medicine, Interfaith Medical Center, Brooklyn, NY, United States, 2Internal Medicine, St.John's Riverside Hospital, Yonkers, NY, United States, 3Internal Medicine, Interfaith Medical Center, Brooklyn, NY, United States.
INTRODUCTION: Kaposi Sarcoma (KS) is the most common malignancy associated with Acquired Immune Deficiency Syndrome (AIDS) and is caused by Human Herpes Virus 8(HHV8) . Clinical features of pulmonary KS might be difficult to distinguish from pneumonia in the immunocompromised patients and could lead to diagnostic challenges. KS is rare in female and it affects men 15 times more than women. We report the case of a young woman who presented with symptoms of pneumonia and was later found to have pulmonary Kaposi sarcoma.
CASE DESCRIPTION: A 33 year old African female, recently diagnosed with HIV and adrenal insufficiency presented to our hospital with hemoptysis, fever, left sided chest pain and worsening shortness of breath for two days. She had a fever of 101.0 F, heart rate 116 bpm, respiratory rate 20/min and Blood pressure 97/69 mmHg. Physical findings were pallor, generalized lymphadenopathy in cervical, bilateral axillary and bilateral inguinal region. Chest examination revealed bilateral crackles. Pneumocystis Jiroveci pneumonia (PJP) and tuberculosis of lungs were ruled out by bronchoscopy with negative bronchoalveolar lavage (BAL) and 3 sets of negative AFB respectively. CT chest showed diffuse airspace consolidation. Patient did not respond to IV antibiotics, steroids, antifungal, antiviral and Bactrim during the course of management. Repeat bronchoscopy with trans bronchial biopsy later confirmed Kaposi sarcoma of lungs.
CONCLUSION: Pulmonary KS is rare, especially in a female patient. It should be considered in the differential diagnosis when HIV infected patients develop rapidly progressive respiratory symptoms, especially after the initiation of glucocorticoid therapy and not responding to antibiotic treatment for pneumonia as corticosteroid can cause exacerbation of KS.
Author Block: B. Bhattarai1, J. Lamichhane2, O. Abdulfattah1, P. B. Datar1, A. Lixon1, M. Hossain3, S. Dahal3, J. B. K. Quist1, D. Enriquez1, M. Schmidt1; 1Pulmonary Medicine, Interfaith Medical Center, Brooklyn, NY, United States, 2Internal Medicine, St.John's Riverside Hospital, Yonkers, NY, United States, 3Internal Medicine, Interfaith Medical Center, Brooklyn, NY, United States.
INTRODUCTION: Kaposi Sarcoma (KS) is the most common malignancy associated with Acquired Immune Deficiency Syndrome (AIDS) and is caused by Human Herpes Virus 8(HHV8) . Clinical features of pulmonary KS might be difficult to distinguish from pneumonia in the immunocompromised patients and could lead to diagnostic challenges. KS is rare in female and it affects men 15 times more than women. We report the case of a young woman who presented with symptoms of pneumonia and was later found to have pulmonary Kaposi sarcoma.
CASE DESCRIPTION: A 33 year old African female, recently diagnosed with HIV and adrenal insufficiency presented to our hospital with hemoptysis, fever, left sided chest pain and worsening shortness of breath for two days. She had a fever of 101.0 F, heart rate 116 bpm, respiratory rate 20/min and Blood pressure 97/69 mmHg. Physical findings were pallor, generalized lymphadenopathy in cervical, bilateral axillary and bilateral inguinal region. Chest examination revealed bilateral crackles. Pneumocystis Jiroveci pneumonia (PJP) and tuberculosis of lungs were ruled out by bronchoscopy with negative bronchoalveolar lavage (BAL) and 3 sets of negative AFB respectively. CT chest showed diffuse airspace consolidation. Patient did not respond to IV antibiotics, steroids, antifungal, antiviral and Bactrim during the course of management. Repeat bronchoscopy with trans bronchial biopsy later confirmed Kaposi sarcoma of lungs.
CONCLUSION: Pulmonary KS is rare, especially in a female patient. It should be considered in the differential diagnosis when HIV infected patients develop rapidly progressive respiratory symptoms, especially after the initiation of glucocorticoid therapy and not responding to antibiotic treatment for pneumonia as corticosteroid can cause exacerbation of KS.
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