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A 65-year-old man of Mediterranean descent is referred by his primary care physician for evaluation of lesions affecting his feet and calves. The patient states the condition was first noted about 4 months ago and remained without symptoms until recently when 1 lesion began to bleed. His only treatment to date has been topical miconazole cream prescribed by a podiatrist for athlete’s foot. He is currently on medication for control of his hypertension. Physical examination reveals scattered violaceous patches and firm, dusky red papules.
Kaposi sarcoma (KS) is a soft tissue tumor linked to infection with human herpesvirus-8 (HHV-8).1 This double-stranded enveloped DNA virus is predominantly transmitted via saliva in childhood and through sexual contact in older individuals. An insufficient T-cell surveillance system underlies pathogenesis.2 After...
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Kaposi sarcoma (KS) is a soft tissue tumor linked to infection with human herpesvirus-8 (HHV-8).1 This double-stranded enveloped DNA virus is predominantly transmitted via saliva in childhood and through sexual contact in older individuals. An insufficient T-cell surveillance system underlies pathogenesis.2 After infection and subsequent immune suppression, HHV-8 activates the Akt/mammalian target of rapamycin (mTOR) pathway leading to persistent and uncontrolled angiogenesis. Expression of specific genes promotes cell cycle progression and inhibits apoptosis in HHV-8 harboring cells.3
Since the recognition of KS, 4 clinical forms have been established: classic, endemic African, AIDS-associated, and iatrogenic.4 Each form presents in different epidemiologic groups. Classic KS has a male:female ratio of 17:1 and primarily affects patients over 50 years old of Eastern European and Mediterranean descent.5 Endemic KS presents extensively throughout Africa and also has a male predominance. AIDS-associated KS arises in infected patients with CD4 counts lower than 200 cells/mm3 and is considered an AIDS-defining illness.6 Iatrogenic KS is seen in transplant patients, especially after solid organ transplantation.7
Kaposi sarcoma begins as a patch and evolves into plaques and eventually tumor stages.8 The patient in this case has classic KS, which does not require aggressive treatment in elderly patients due to its indolent course. Therapeutic options include localized excision, cryosurgery, and intralesional vincristine. Topical medications such as alitretinoin, imiquimod, and timolol, have also induced clearance of lesions.9
Sidney Lampert is a medical student at the Drexel University College of Medicine, in Philadelphia. Stephen Schleicher, MD, is director of the DermDox Dermatology Centers, associate professor of medicine at Geisinger Commonwealth Medical College.
References
1. Bisceglia M, Minenna E, Altobella A, et al. Anaplastic Kaposi sarcoma of the adrenal in an HIV-negative patient with literature review. Adv Anat Pathol. 2019;26(2):133-149. doi:10.1097/PAP.0000000000000213
2. Mariggiò G, Koch S, Schulz TF. Kaposi sarcoma herpesvirus pathogenesis. Philos Trans R Soc Lond B Biol Sci. 2017;372(1732):20160275. doi:10.1098/rstb.2016.0275
3. Kaplan LD. Human herpesvirus-8: Kaposi sarcoma, multicentric Castleman disease, and primary effusion lymphoma. Hematology Am Soc Hematol Educ Program. 2013;2013:103-108. doi:10.1182/asheducation-2013.1.103
4. Radu O, Pantanowitz L. Kaposi sarcoma. Arch Pathol Lab Med. 2013;137(2):289-294. doi:10.5858/arpa.2012-0101-RS
5. Bishop BN, Lynch DT. Kaposi Sarcoma. In: StatPearls [Internet]. StatPearls Publishing; Updated June 5.
6. Tounouga DN, Kouotou EA, Nansseu JR, Zoung-Kanyi Bissek AC. Epidemiological and clinical patterns of Kaposi sarcoma: a 16-year retrospective cross-sectional study from Yaoundé, Cameroon. Dermatology. 2018;234(5-6):198-204. doi:10.1159/000492175
7. Ariza-Heredia EJ, Razonable RR. Human herpes virus 8 in solid organ transplantation. Transplantation. 2011;92(8):837-844. doi:10.1097/TP.0b013e31823104ec.
8. OʼDonnell PJ, Pantanowitz L, Grayson W. Unique histologic variants of cutaneous Kaposi sarcoma. Am J Dermatopathol. 2010;32(3):244-250. doi:10.1097/DAD.0b013e3181b7f6a7
9. Htet KZ, Waul MA, Leslie KS. Topical treatments for Kaposi sarcoma: a systematic review. Skin Health Dis. 2022;2(2):e107. doi:10.1002/ski2.107
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