title: Vertebral Lesions from AIDS-Related Kaposi's Sarcoma.
abstract: BACKGROUND
  Kaposi's sarcoma is commonly described in HIV/AIDS patients but usually manifests as overt skin lesions or visceral involvement. Bone involvement, particularly vertebral, is uncommon, especially when there is no adjacent cutaneous lesion but a small number of cases have been reported. Unlike many other diseases associated with HIV, Kaposi's sarcoma can occur despite a normal CD4 count.
  
  
  METHODS
  A 44 year-old HIV positive Nigerian man presented with a 20 day history of severe, worsening lumbar back pain, nearly three years after an earlier diagnosis of a single cutaneous lesion consistent with Kaposi's sarcoma, for which he received chemo-radiotherapy. Despite varying previous compliance with his anti-retroviral therapy, he was thought to be taking his medications at time of presentation and his CD4 count was 408 cells/mm(3). No other organ involvement was found but a pathological fracture was seen on magnetic resonance imaging affecting L1 vertebra. A CT-guided needle aspiration biopsy was performed and a histological diagnosis subsequently confirmed Kaposi's sarcoma. The patient was treated with further courses of radiotherapy but had little clinical improvement. Indeed, a follow-up MRI four months later showed new involvement of a further four vertebrae, fortunately in the absence of progressive focal neurology.
  
  
  CONCLUSIONS
  Vertebral Kaposi's sarcoma is a rare diagnosis but can be accurately diagnosed with CT or MRI imaging in conjunction with a histological diagnosis. An immunosuppressed patient presenting with bone pain should be thoroughly investigated for Kaposi's sarcoma as modern chemotherapeutic agents alongside anti-retroviral therapy may delay or prevent further devastating complications such as spinal cord compression.
authors.affiliation: 2nd Infectious Diseases Division, National Institute for Infectious Diseases, "Lazzaro Spallanzani", Rome, Italy. stefano932@gmail.com
authors.forename: S
authors.initials: S
authors.lastname: Di Bella
authors.forename: A
authors.initials: A
authors.lastname: Capone
authors.forename: F
authors.initials: F
authors.lastname: Olearo
authors.forename: E
authors.initials: E
authors.lastname: Johnson
authors.forename: P
authors.initials: P
authors.lastname: Chinello
authors.forename: A
authors.initials: A
authors.lastname: Baiocchini
authors.forename: F
authors.initials: F
authors.lastname: Del Nonno
authors.forename: E
authors.initials: E
authors.lastname: Busi Rizzi
authors.forename: N
authors.initials: N
authors.lastname: Petrosillo
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D005598:Fractures, Spontaneous / Q000209:etiology; D006801:Humans; D007866:Leg; D008159:Lumbar Vertebrae / Q000293:injuries; D008279:Magnetic Resonance Imaging; D008297:Male; D012514:Sarcoma, Kaposi / Q000532:radiotherapy / Q000556:secondary*; D012878:Skin Neoplasms; D016103:Spinal Fractures / Q000209:etiology*; D013125:Spinal Neoplasms / Q000532:radiotherapy / Q000556:secondary*; D016896:Treatment Outcome