BACKGROUND: Kaposi sarcoma (KS) flare may occur following therapy with corticosteroids, as part of the immune reconstitution inflammatory syndrome seen with highly active antiretroviral therapy (HAART), and after rituximab therapy. The exact mechanism responsible for iatrogenic KS flare is unclear. METHODS: A case of AIDS-associated cutaneous KS flare following rituximab therapy was compared to similar controls by means of immunohistochemistry using vascular makers (CD34, CD31), monoclonal antibodies to Human Herpesvirus 8 (HHV8) gene products (LNA-1, K5), as well as B-lymphocyte (CD20) and T-lymphocyte (CD3, CD4, CD8) markers. RESULTS: CD20+ B-cell depletion with rituximab in KS flare occurred concomitantly with activation of the HHV8 immediate early gene protein K5. KS flare in this patient was successfully treated with liposomal doxorubicin and valganciclovir. CONCLUSION: Rituximab-induced KS flare appears to be related to HHV8 activation. Effective management of iatrogenic KS flare therefore depends upon the control of HHV8 viremia in conjunction with specific chemotherapy for KS.
BACKGROUND:Kaposi sarcoma (KS) flare may occur following therapy with corticosteroids, as part of the immune reconstitution inflammatory syndrome seen with highly active antiretroviral therapy (HAART), and after rituximab therapy. The exact mechanism responsible for iatrogenic KS flare is unclear. METHODS: A case of AIDS-associated cutaneous KS flare following rituximab therapy was compared to similar controls by means of immunohistochemistry using vascular makers (CD34, CD31), monoclonal antibodies to Human Herpesvirus 8 (HHV8) gene products (LNA-1, K5), as well as B-lymphocyte (CD20) and T-lymphocyte (CD3, CD4, CD8) markers. RESULTS:CD20+ B-cell depletion with rituximab in KS flare occurred concomitantly with activation of the HHV8 immediate early gene protein K5. KS flare in this patient was successfully treated with liposomal doxorubicin and valganciclovir. CONCLUSION:Rituximab-induced KS flare appears to be related to HHV8 activation. Effective management of iatrogenic KS flare therefore depends upon the control of HHV8 viremia in conjunction with specific chemotherapy for KS.
Authors: Mark Bower; Tom Powles; Sarah Williams; Tom Newsom Davis; Mark Atkins; Silvia Montoto; Chloe Orkin; Andy Webb; Martin Fisher; Mark Nelson; Brian Gazzard; Justin Stebbing; Peter Kelleher Journal: Ann Intern Med Date: 2007-12-18 Impact factor: 25.391
Authors: Lan Lin; Jeannette Y Lee; Lawrence D Kaplan; Bruce J Dezube; Ariela Noy; Susan E Krown; Alexandra M Levine; Yanxing Yu; Gary S Hayward; Richard F Ambinder Journal: J Clin Oncol Date: 2009-04-06 Impact factor: 44.544
Authors: Mina C Hosseinipour; Kristen M Sweet; Jie Xiong; Dan Namarika; Albert Mwafongo; Michael Nyirenda; Loreen Chiwoko; Deborah Kamwendo; Irving Hoffman; Jeannette Lee; Sam Phiri; Wolfgang Vahrson; Blossom Damania; Dirk P Dittmer Journal: mBio Date: 2014-09-23 Impact factor: 7.867