[Successful treatment with liposomal doxorubicin and foscarnet in a patient with widespread Kaposi's sarcoma and human herpes virus 8-related, serious hemophagocytic syndrome, after renal transplantation].
BACKGROUND
It is well known that the human herpes virus 8 (HHV8) is linked to several malignancies such as Kaposi's sarcoma (KS). Moreover, pancytopenia due to hemophagocytic syndrome could be associated with HHV8 infection. In renal transplant recipients affected by KS, the tapering of immunosuppression often leads to KS remission, but also results in graft loss in >50% of cases. Chemotherapy and antiviral therapy have also been used, mainly in the presence of visceral involvement.


METHODS
We describe a transplant recipient with widespread cutaneous and visceral KS HHV8 associated, complicated by hemophagocytic syndrome. At transplantation the patient's serology for HHV8 was negative, but thereafter it became positive. The first step in treatment (cyclosporine dose reduction until suspension) failed to improve the clinical course. Therefore, therapy combining liposomal doxorubicin and foscarnet was started. Clearance of HHV8 in the blood and complete resolution of the KS lesions were achieved. Immunosuppression with cyclosporine was resumed. No KS relapse has occurred, blood tests for HHV8 are negative, and graft function is good after a 5-yr follow-up.


CONCLUSIONS
Therapy combining liposomal doxorubicin and foscarnet was effective in this renal transplant recipient with KS and HHV8 infection and enabled us to resume immunosuppressive therapy; therefore, reducing the risk of acute/chronic rejection.
Bossini
N
N
Divisione e Cattedra di Nefrologia, Spedali Civili e Universita' di Brescia, 25100 Brescia, Italy. Bossini-Nicola@libero.it
Sandrini
S
S
Setti
G
G
Luppi
M
M
Maiorca
P
P
Maffei
C
C
Cancarini
G
G
D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage*; D016572:Cyclosporine / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage*; D017245:Foscarnet / Q000008:administration & dosage*; D019288:Herpesvirus 8, Human; D015616:Histiocytosis, Non-Langerhans-Cell / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage*; D012514:Sarcoma, Kaposi / Q000188:drug therapy* / Q000821:virology; D016896:Treatment Outcome
D000903:Antibiotics, Antineoplastic; D007166:Immunosuppressive Agents; D018894:Reverse Transcriptase Inhibitors; D017245:Foscarnet; D004317:Doxorubicin; D016572:Cyclosporine