Isolated penile Kaposi's sarcoma in a HIV-positive patient stable on treatment for three years.
Kaposi's sarcoma (KS) is an AIDS-defining condition. Typically, KS affects the skin with or without visceral involvement. The extensive use of antiretroviral therapy (ART) has decreased the incidence of KS amongst the HIV-positive population. We report a case of a 40-year-old man with HIV-1 infection with CD4 count of 551 cells/mm(3)and an undetectable viral load who presented with two skin-coloured KS lesions on the prepuce of the penis. Diagnosis was confirmed by histopathology. He had been commenced on ART three years earlier with a nadir CD4 count of 255 cells/mm(3) He had achieved and maintained viral suppression since commencing ART. The patient was initially treated with cryotherapy and 5% imiquimod as the lesions were presumed to be warts. The lack of response to treatment prompted further investigation. We carried out a literature search of published cases of penile KS over the past 10 years. The majority of articles regarding penile KS were published in the pre-ART era and involved patients with AIDS. Over the past 10 years, published cases of penile KS have almost exclusively been in HIV-negative men. We found 10 published cases of penile KS in HIV-negative men and only one other published case of penile KS in a HIV-positive man, who had severe immune suppression with CD4 count below 200 cells/mm(3) This is the first case report to describe a HIV-positive patient stable on ART with a CD4 count above 200 cells/mm(3)and suppressed HIV-1 viral load, to develop two KS lesions on the penis. Clinicians have to remain suspicious of penile lesions and appreciate the crucial role a biopsy with histopathological analysis plays in confirming a diagnosis. In addition, this case illustrates that unusual presentations of KS can still occur in treated HIV-positive patients with sustained immune recovery.
Blackpool Sexual Health Services, Whitegate Health Centre, Blackpool, UK dornubari.lebari@nhs.net.
Dornubari
D
Lebari
University of Liverpool Medical School, Liverpool, UK.
Jesal
J
Gohil
Department of Histopathology, Blackpool Victoria Teaching Hospital, Blackpool, UK.
Lipsita
L
Patnaik
Blackpool Sexual Health Services, Whitegate Health Centre, Blackpool, UK.
Wafaa
W
Wasef
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D003937:Diagnosis, Differential; D006679:HIV Seropositivity / Q000150:complications / Q000188:drug therapy / Q000821:virology; D015497:HIV-1 / Q000187:drug effects / Q000302:isolation & purification; D019288:Herpesvirus 8, Human / Q000302:isolation & purification; D006801:Humans; D008297:Male; D010412:Penile Neoplasms / Q000209:etiology / Q000473:pathology*; D012514:Sarcoma, Kaposi / Q000209:etiology / Q000473:pathology* / Q000821:virology; D019562:Viral Load
D019380:Anti-HIV Agents
AIDS; HIV; Kaposi’s sarcoma; antiretroviral therapy; human herpesvirus-8; male genitalia; penile; tumour; wart