Conjunctival Kaposi’s sarcoma in patient with HIV-AIDS
Kaposi’s sarcoma is a cancer that affects the conjunctiva and eyelids. The conjunctival tumour is red to pink in appearance, whereas the eyelid tumour is blue to purple. It is commonly found in patients with HIV acquired immunodeficiency syndrome (AIDS), although is also seen in elderly and immunocompromised or transplant patients. Classic kaposi’s sarcoma is slowly progressive and often seen in the elderly.
Case study
This article describes the case of a 50-year-old who presented to the ophthalmology clinic with complaint of a large lesion in the left eye. According to the patient the lesion had developed a month ago. Physical examination was significant for a red, mobile, nodular mass on the inferior bulbar conjunctiva. Other findings included the presence of violaceous plaques on the patient’s back and lower limbs.
Diagnosis and treatment
Doctors advised the patient to be tested for human immunodeficiency virus (HIV) type 1, the results of which came back positive. Tests showed a viral load of “147,000 copies per millilitre (reference range, <40), and the CD4 cell count was 116 per cubic millimeter (reference range, 500 to 1200)”. A specimen of the skin was biopsied which was significant for spindle-cell neoplasm. In addition, immunohistochemical testing for human herpesvirus 8 was also positive. Based on these findings, doctors diagnosed the patient with Kaposi’s sarcoma. A malignant vascular neoplasm linked with human herpesvirus 8 infection. It is typically seen in patients with immunodeficiency. Therefore, it is important for clinicians to consider the diagnosis of conjunctival Kaposi’s sarcoma in case of rapidly enlarging vascular or bleeding lesions in the eye in a patient with HIV infection.
In case of suspicion of conjunctival tumour being Kaposi’s sarcoma, it is important to examine the patient’s skin and lymph nodes. The patient should further be tested for HIV, lymphocytes and other opportunistic diseases. Diagnosis can also be made based on a biopsy. The diagnosis can also be presumptive in patient’s with a history of Kaposi’s. The only problem is that these patients are also quite likely of developing squamous and lymphoid conjunctival tumours.
Doctors treated the patient with antiretroviral therapy and doxcubicin. The conjunctival mass and skin lesions resolved five months after presentation. Treatment options generally depend on the patient’s, immune status, current medications and overall general health. Small sarcomas can be removed at biopsy with employment of chemotherapy, radiation therapy and biologic therapy. However, in case of HIV-AIDS, any treatment that would suppress the patient’s immune system.
Source: NEJM
