A Case of Recurrent Kaposi’s Sarcoma in an HIV-Negative Patient

Abstract

Background: Kaposi’s Sarcoma (KS) is an angioproliferative disease of endothelial tissue, as a result of Human Herpesvirus 8 (HHV-8) infection. Theoretically, there are four types of KS: Classic, Epidemic, Endemic, and Iatrogenic. The Classic variant is seen among men of 50–70 years of age, of Mediterranean or European descent. The Epidemic form is seen among HIV seropositive patients. The Endemic variant is seen among HIV seronegative men, of African American descent, typically 20–30 years of age, and lastly, the Iatrogenic subtype is seen among those undergoing immunosuppressive treatment. In this paper, we present a case of an HIV-negative, non-immunocompromised patient with recurrent Human Herpesvirus 8 (HHV-8) positive Kaposi’s Sarcoma, who does not resemble any of the aforementioned types. Presentation: A 65-year-old male presented to the outpatient clinic with the chief complaint of a nodular lesion over the left posterior thigh for the past two months. Past history was significant for biopsy-confirmed Kaposi’s sarcoma over the right thigh four months prior. There was no history of an immunocompromised state and testing for HIV returned negative. The patient’s complete blood count and complete metabolic panel were normal, and the patient had no signs of any underlying systemic illness. The patient underwent surgical excision of the lesion on the left lower extremity, which revealed Kaposi’s sarcoma, nodular type with immunohistochemical staining of lesional cells positive for HHV-8, and with clear margins. Conclusion: The pathogenesis of KS has been attributed to viral oncogenesis as a result of dysfunction of the p53 tumor suppressor gene. Establishing this mechanism required decades of research, and through this process, it has been elucidated that immunosuppression is necessary for KS tumorigenesis. However, data is now emerging on the occurrence of KS in immunocompetent individuals, thus highlighting the importance of further research in the understanding of this tumor’s pathogenesis. Additionally, to the best of our knowledge recurrent KS in an immunocompetent individual has been sparingly described, especially in a non-endemic population.

Keywords

• kaposi sarcoma
• atypical
• hiv-negative