Ocular Kaposi's sarcoma as the first manifestation of HIV infection.

A 51-year-old male presented with a three-months history of a raised lesion in the inferior eyelid of the right eye and small nodules of dark red colour present on his nose. The ocular lesion initially diagnosed as an ocular angioma, failed to respond to treatment and required further medical examinations and an immunological consult. A positive test for HIV, lower CD4+ cell count (148cells/μl), elevated HIV plasma levels (100.000 viral copies), established the diagnosis of AIDS. Histological examination detected the presence of spindle cells and the positivity for Kaposi-associated Herpes virus-8 confirmed the lesions as Kaposi’s sarcoma [1], [2], [3]. Visceral sarcoma lesions were also present in the ascending colon and gastric fundus. Treatment with antiretroviral therapy (dolutegravir and truvada) and the first cycle of doxorubicina was initiated immediately. Although Kaposi’s sarcoma was historically the harbinger of epidemics AIDS, is now rarely seen in HIV-positive patients as first presentation [4], [5]. In this case the ocular Kaposi sarcoma was the first manifestation of HIV infection and its initial diagnosis was completely misunderstood (Fig. 1).

Fig. 1

This picture illustrates an isolated conjunctival Kaposi’s sarcoma as primary presentation of AIDS. A raised ocular lesion and small nodules of dark red colour are visible.