Clinical Scorecard: Pulmonary Kaposi Sarcoma in Advanced HIV With Flame-Like Opacities on Chest CT

At a Glance

Key Highlights

• The patient had progressive dyspnea, productive cough, violaceous skin lesions, and a CD4 nadir below 50 cells/µL.
• Chest CT showed bilateral, asymmetric, flame-shaped nodular opacities along peri-bronchovascular regions, predominantly on the left.
• The initial scant core biopsy suggested adenocarcinoma but was inconsistent with the clinical and radiographic findings.
• Repeat CT-guided samples from the left lower lobe and lingula confirmed Kaposi sarcoma with HHV-8 latent nuclear antigen-1 positivity.

Guideline-Based Recommendations

Diagnosis

• In this case, flame-shaped peri-bronchovascular opacities in a patient with advanced HIV raised suspicion for pulmonary Kaposi sarcoma; repeat samples showed spindle-cell vascular proliferation and HHV-8 latent nuclear antigen-1 positivity.

Management

• In this case, repeat CT-guided sampling was performed because the initial specimen was scant and its findings conflicted with the clinical and radiographic picture.

Monitoring & Follow-up

Risks

• The article states that pulmonary Kaposi sarcoma can be overlooked on an initial tissue-limited biopsy.
• The article notes that similar CT findings can occur with Pneumocystis jirovecii pneumonia, invasive fungal infection, and mycobacterial infection.

Patient & Prescribing Data

A 61-year-old man with advanced HIV, a CD4 nadir below 50 cells/µL, progressive dyspnea, productive cough, and violaceous skin lesions.

Concurrent Mycobacterium avium complex and Cryptococcus neoformans infections were treated with azithromycin/ethambutol and fluconazole, respectively. The article does not report treatment for Kaposi sarcoma.

Clinical Best Practices

• The article’s teaching point is to correlate the flame-shaped CT pattern with confirmatory histopathology.
• In this case, repeat tissue sampling incorporating HHV-8 immunohistochemistry followed an initial scant biopsy that conflicted with the clinical and radiographic findings.

Related Resources & Content

• References cited in the article: (1–4); bibliographic details and URLs not provided.