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Brazilian Journal of Infectious Diseases

versão impressa ISSN 1413-8670versão On-line ISSN 1678-4391

Braz J Infect Dis vol.19 no.4 Salvador jul./ago. 2015

https://doi.org/10.1016/j.bjid.2015.04.001 

Clinical Images

Kaposi's sarcoma simulating verrucous syndrome

Cassio Porto Ferreira1  * 

Alice Miranda1 

José Augusto da Costa Nery1 

1Ambulatório Souza Araújo, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil


Report

Kaposi's sarcoma (KS) is a vascular lesion of low-grade malignant potential and is the most frequent neoplasm in acquired immunodeficiency syndrome (AIDS).1 Typical cases can present with erythematous or violaceous lesions, plaques or nodules, but the hyperkeratotic variants are rare.1

A 31-year-old woman presented with a 6-year history of intractable injury in the left foot with worsening in pain and difficulty walking. The patient had a positive serology for HIV and reported intermittent and irregular use of antiretroviral therapy. On examination, a vegetative lesion with 20 cm in its largest diameter located on the medial side and plantar region of the left foot (Fig. 1(1, 2)) was noted. Fungal, bacteria/mycobacteria cultures were negative. Skin biopsy revealed hyperkeratosis and dermis with proliferation of mesenchymal lineage cells with formation of malformed vessels with the presence of red blood cells out of the light thereof (Fig. 1A-C). KS is a vascular neoplasm from vascular and lymphatic endothelium caused by human herpesvirus 8.1 Four different types of KS are distinguished: classic (Mediterranean), endemic (African), iatrogenic (transplant-related), and epidemic (AIDS-related).1 Hyperkeratotic KS is a rarely described clinicopathalogic variant of KS.2 There is verrucous epidermal acanthosis and hyperkeratosis overlying an often fibrotic epidermis.2 The explanation for the hyperkeratotic variant of KS may be the high interstitial protein concentration that retains fluid in the connective tissue, in turn leading to chronic inflammation causing fibrosis and hyperkeratosis.3

Fig. 1 (1) Hyperkeratotic KS on the medial side and plantar region of the left foot. (2) Hyperkeratotic KS (in more detail). Epidermis with hyperkeratosis (A) and dermis with proliferation of mesenchymal lineage cells and malformed vessels with the presence of red blood cells out of the light thereof (B and C). 

Highly active antiretroviral therapy (HAART) has greatly changed the clinical course of HIV-infected patients and several epidemiological studies indicate a decrease of several opportunistic infections and Kaposi's sarcoma. 4

REFERENCES

Mohanna S, Maco V, Bravo F, Gotuzzo E. Epidemiology and clinical characteristics of classic Kaposi's sarcoma, seroprevalence, and variants of human herpesvirus-8 in South America: a critical review of an old disease. Int J Infect Dis. 2005;9:239-50. [ Links ]

Grayson W, Pantanowitz L. Histological variants of cutaneous Kaposi sarcoma. Diagn Pathol. 2008;25:31. [ Links ]

Hengge UR, Stocks K, Goos M.Acquiredimmune de?ciency syndrome-related hyperkeratotic Kaposi's sarcoma with severelymphoedema: report of ?ve cases. Br J Dermatol. 2000;142:501-5. [ Links ]

Easterbrook P, Meadway J. The changing epidemiology of HIV infection: new challenges for HIV palliative care. J R Soc Med. 2001;94:442-8. [ Links ]

Role of funding sourceNone.

Ethics committee approvalCEP 14/2001 Instituto Oswaldo Cruz - CPqHEC/FIOCRUZ.

Received: March 31, 2015; Accepted: April 05, 2015

* Corresponding author at: Oswaldo Cruz Foundation - FIOCRUZ, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro 21045-900, Brazil. E-mail address: drcassioferreira@yahoo.com.br(C.P. Ferreira).

Authors' contributionsCassio Porto Ferreira and José Augusto da Costa Nery contributed to clinical care and paper preparation. Alice Miranda contributed to laboratory diagnosis and paper preparation.

Conflicts of interestThe authors declare no conflicts of interest.

Creative Commons License This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.