Cavitary pulmonary Kaposi's sarcoma in AIDS.

Many different pulmonary diseases occur in human immunodeficiency virus-infected patients. This was a case of a cavity lesion, although differentiation was extremely difficult pictorially. This was a rare case that led to a definitive diagnosis because the cavity lesions were complicated by pneumothorax, and we could perform a biopsy.

Case illustrated

The patient was a 42-year-old man who presented with bloody sputum and weight loss. He had no medical history, nor was he taking any oral medications. However, a lung shadow was reportedly discovered during a medical examination performed 2 years prior in a clinic. He consulted our hospital with bloody sputum and a history of having lost 17 kg over 1 year.

At the consultation, his vital signs were Glasgow Coma Scale, E4V5M6; temperature, 37.1 °C; blood pressure, 114/84 mmHg; pulse, 96/min (regular); respirations, 16/min; and percutaneous oxygen saturation on room air (98 %). A physical examination revealed no abnormal findings. Chest radiography showed nodular shadows in the bilateral lower lung fields (Fig. 1). Chest computed tomography showed multiple nodular shadows with cavities with a greatest dimension of 3 cm in the bilateral inferior lobes of the lung (Fig. 2). During an interview, he revealed that he had sex with other men. The blood test results were as follows: white blood cell count, 3400/μL; C-reactive protein level, 0.34 mg/dL; CD4 count, 45/μL; and HIV-RNA viral load, 320,000 copies/mL.

Fig. 1

Chest radiograph showing nodular shadows visible in the bilateral lower lung fields.

Fig. 2

Chest computed tomography image showing multiple nodular shadows with cavities (greatest dimension, 3 cm) in the bilateral inferior lobes of the lung.

Bronchoscopy was performed to confirm the diagnosis. However, a right lung class I pneumothorax was detected; thus, the bronchoscopy was discontinued (Fig. 3-A). Conservative medical treatment was initiated, but the patient developed a contralateral left class 2 pneumothorax (Fig. 3-B). As the suspected etiology of the air leak from the cavity lesions was inconclusive, he underwent a diagnostic and therapeutic pulmonary segmental resection, after which a definitive diagnosis was reached on hospitalization day 25. Pathology revealed Kaposi’s sarcoma (Fig. 4-A, B, C). Subsequently, chemotherapy consisting of liposomal doxorubicin and antiretroviral therapy (bictegravir sodium, emtricitabine, and tenofovir alafenamide fumarate) was administered, and a subsequent reduction in the cavity shadows was detected (Fig. 5).

Fig. 3

A: A class I pneumothorax that was detected in the right lung on hospitalization day 14. B: A class II pneumothorax that was detected in the left lung on hospitalization day 23.

Fig. 4

A:Left lower lobe of the lung segmental resection specimen (S9: 4 cm × 3 cm). B: The dyskaryotic tumor cells showed hyperplasia with fusiform nuclei. C: Immunostaining results: CD31-positive.

Fig. 5

Reductions in the cavity shadows were detected in a wall 1 year after treatment.

According to one report, among patients with HIV infection and cavitary lung lesions, fungi was the most common etiology (42.0 %), followed by bacteria (29.6 %) and mycobacteria (25.9 %) [1]. Noninfectious causes of cavitary lesions in patients with HIV infection are rare, but cavitary lesions caused by pulmonary Kaposi’s sarcoma and non-Hodgkin’s lymphoma have been reported [2]. Furthermore, this case is rare because there have been few reports of Kaposi’s sarcoma lesions occurring at the tip of the lung and resulting in complicated pneumothorax [3].

Authors’ contributions

All authors treated the patient, drafted the manuscript, critically reviewed the manuscript, and approved its final version.

Ethical approval

No ethical approval was required for this publication.

Role of the funding source

This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.

Consent

Informed consent was obtained from the patient.

Declaration of Competing Interest

The authors report no declarations of interest.