Background

A 74-year-old woman with primary biliary cirrhosis under immunosuppression with azathioprine (50 mg/day) presented multiple violaceous papules and plaques with some associated edema on the distal lower right extremity (Figure 1). Physical examination also revealed multiple right inguinal adenopathies. She had no history of fever, weight loss, or night sweats. There was no change on the complete blood count test and no other notable findings on thoraco-abdominopelvic computed tomography besides the pathological appearance of the adenopathies mentioned above. An excisional biopsy was performed with immunohistochemical staining positive for human herpesvirus-8 (Figure 2). Serological tests for Human Immunodeficiency Virus (HIV) were negative. The immunosuppression was suspended with complete regression of the lesions over three months and no recrudescence over time.

Kaposi’s sarcoma is classified into four types according to the circumstances in which it develops: classical, endemic, iatrogenic, and epidemic (associated with HIV infection). Iatrogenic Kaposi’s sarcoma cases mainly refer to situations of immunosuppression by solid organ transplantation. Presentations associated with immunosuppression due to other causes are sparsely described across the literature. It typically affects older patients (>50 years), mainly in distal extremities, and visceral involvement is relatively common (lymphatic and gastrointestinal). The modification of the immunosuppression regimen is the basis of its treatment [1,2].

Figure 1: Multiple violaceous papules and plaques are present on the distal lower extremity of this patient with iatrogenic Kaposis’s sarcoma.

Figure 2: The immunohistochemistry with antibodies for HHV-8 demonstrated nuclear granular positivity in neoplastic cells.

Declarations

The authors have no conflicts of interest. The authors did not receive funding to write this paper from any entity in the public or private domains.

References

1. BrambillaL, Genovese G, Berti E. Diagnosis and treatment of classic and iatrogenic Kaposi’s sarcoma: Italian recommendations. Ital Dermatol Venerol. 2021; 156: 356-365.
2. Akao S, Yano H, Kinjo M. IatrogenicPenile Kaposi Sarcoma. Intern Med. 2020; 59: 2445.