title: Kaposi's sarcoma after long-acting steroids: time until remission and drug washout.
abstract: Long-acting steroids (LAS) are widely used to treat various inflammatory diseases and allergies. They have many adverse effects including the inhibition of the hypothalamopituitary axis that can last several months. LAS are also strong immunosuppressors and can result in severe opportunistic infections and immunodeficiency-related malignancies. However, the time needed for immune recovery after withdrawal of LAS is unknown. Here we report a case of Kaposi's sarcoma (KS) and severe immunosuppression after a chronic triamcinolone acetonide (TA) treatment. Six months after withdrawal, traces of TA were still detected in the serum by HPLC mass spectrometry. At 8 months, the drug became undetectable, and clinical and biological signs of immune recovery - beginning of KS regression, normalization of IgG levels and CD4 T lymphocyte counts - became noticeable. We then provide a review of the literature on the time until remission of KS after immunosuppression reduction. We also reviewed the cases of KS induced by TA, and the metabolic side effects of TA when compared to standard glucocorticoids.
authors.affiliation: Department of Dermatology, Hôpital Saint-Louis, AP-HP, Paris, France. dany.nassar@inserm.fr
authors.forename: D
authors.initials: D
authors.lastname: Nassar
authors.forename: N E C
authors.initials: NE
authors.lastname: Schartz
authors.forename: C
authors.initials: C
authors.lastname: Bouché
authors.forename: A
authors.initials: A
authors.lastname: Lévy
authors.forename: D
authors.initials: D
authors.lastname: Kerob
authors.forename: F
authors.initials: F
authors.lastname: Agbalika
authors.forename: M
authors.initials: M
authors.lastname: Lafaurie
authors.forename: C
authors.initials: C
authors.lastname: Lebbé
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D001761:Bleomycin / Q000627:therapeutic use; D001786:Blood Glucose / Q000187:drug effects; D018791:CD4 Lymphocyte Count; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007328:Insulin / Q000627:therapeutic use; D016898:Interferon-alpha / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000276:immunology* / Q000473:pathology; D017239:Paclitaxel / Q000627:therapeutic use; D012514:Sarcoma, Kaposi / Q000276:immunology* / Q000473:pathology; D012883:Skin Ulcer / Q000139:chemically induced / Q000276:immunology; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood
chemical_list: D000893:Anti-Inflammatory Agents; D001786:Blood Glucose; D007074:Immunoglobulin G; D007328:Insulin; D016898:Interferon-alpha; D001761:Bleomycin; D014222:Triamcinolone Acetonide; D017239:Paclitaxel