title: Granulomas in acquired immunodeficiency syndrome-associated cutaneous Kaposi sarcoma: evidence for a role for Mycobacterium tuberculosis.
abstract: BACKGROUND
  Co-lesional acquired immunodeficiency syndrome-associated cutaneous Kaposi sarcoma (AIDS-KS) and Mycobacterium tuberculosis-associated granulomatous inflammation are undocumented.
  
  
  METHODS
  Retrospective appraisal of skin biopsies with co-lesional AIDS-KS and microscopic tuberculosis (TB).
  
  
  RESULTS
  Sixteen biopsies from nine males and seven females form the study cohort. Histological assessment confirmed nodular and plaque KS in 12 and 4 cases each, respectively. Necrotizing, non-necrotizing and a combination of necrotizing and non-necrotizing granulomatous inflammation were present in nine, two and five biopsies each, respectively. The identification of acid fast bacilli on Ziehl-Neelsen staining and M. tuberculosis on polymerase chain reaction confirmed co-lesional TB in 15/16 biopsies. Co-lesional AIDS-KS and lichen scrofulosorum, hitherto undocumented, were confirmed in one biopsy. The histopathological findings served as a marker of human immunodeficiency virus (HIV) infection, visceral TB, therapeutic noncompliance and multidrug resistant pulmonary TB in nine, eight, five and one patient, respectively. M. tuberculosis was cultured from sputum or nodal tissue of all patients.
  
  
  CONCLUSIONS
  Granulomatous inflammation in KS requires optimal histopathological and molecular investigation to confirm an M. tuberculosis origin. The cutaneous co-lesional occurrence of AIDS-KS and microscopic TB may serve as the sentinel clue to HIV infection, systemic TB, therapeutic noncompliance or multidrug resistant TB.
authors.affiliation: Department of Anatomical Pathology, National Health Laboratory Service, Durban, KwaZulu Natal, South Africa. ramdial@ukzn.ac.za
authors.forename: Pratistadevi K
authors.initials: PK
authors.lastname: Ramdial
authors.forename: Yetish
authors.initials: Y
authors.lastname: Sing
authors.forename: Sumeshini
authors.initials: S
authors.lastname: Subrayan
authors.forename: Eduardo
authors.initials: E
authors.lastname: Calonje
authors.forename: Jamila
authors.initials: J
authors.lastname: Aboobaker
authors.forename: Clive
authors.initials: C
authors.lastname: Sydney
authors.forename: Dinesh
authors.initials: D
authors.lastname: Sookdeo
authors.forename: Amsha
authors.initials: A
authors.lastname: Ramburan
authors.forename: Thandinkosi E
authors.initials: TE
authors.lastname: Madiba
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000382:microbiology* / Q000473:pathology; D000328:Adult; D005260:Female; D006099:Granuloma / Q000150:complications / Q000382:microbiology* / Q000473:pathology; D006801:Humans; D008297:Male; D009169:Mycobacterium tuberculosis; D012189:Retrospective Studies; D012514:Sarcoma, Kaposi / Q000150:complications / Q000382:microbiology* / Q000473:pathology; D012878:Skin Neoplasms / Q000150:complications / Q000382:microbiology* / Q000473:pathology