title: Pulmonary Kaposi sarcoma and disseminated Mycobacterium genavense infection in an HIV-infected patient.
abstract: We report a case of Kaposi sarcoma (KS) and disseminated infection by Mycobacterium genavense in a 40-year-old HIV-positive man with CD4+ T-cell count 5/µL. He presented with anorexia, diarrhoea, cachexia and multiple firm violaceous nodules distributed over the face, neck and upper and lower extremities. Biopsy of a skin nodule was performed, confirming KS. Immunoperoxidase staining for human herpesvirus 8 was strongly positive. Endoscopic examination revealed erosive duodenopathy. Multiple biopsy samples showed numerous acid-fast bacilli at direct microscopic examination. Real-time PCR (RT-PCR) identified M. genavense. A CT scan showed diffuse pulmonary inﬁltrates with a 'tree-in-bud' appearance, striking splenomegaly and abdominal lymphadenopathy. A bronchoscopy was performed, revealing typical Kaposi's lesions in the upper respiratory tract. RT-PCR of bronchial aspirate identified M. genavense and Pneumocystis jirovecii. Despite treatment with highly active antiretroviral therapy, antimycobacterial therapy and trimethoprim/sulfamethoxazole, the outcome was fatal.
authors.affiliation: Department of Internal Medicine, Hospital of Braga, Braga, Portugal.
authors.forename: Cindy
authors.identifier: http://orcid.org/0000-0003-1858-676X
authors.initials: C
authors.lastname: Tribuna
authors.affiliation: Department of Internal Medicine, Hospital of Braga, Braga, Portugal.
authors.forename: Cristina
authors.initials: C
authors.lastname: Ângela
authors.affiliation: Department of Internal Medicine, Hospital of Braga, Braga, Portugal.
authors.forename: Isabel
authors.initials: I
authors.lastname: Eira
authors.affiliation: Department of Internal Medicine, Hospital of Braga, Braga, Portugal.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Carvalho
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D001706:Biopsy; D001999:Bronchoscopy; D015496:CD4-Positive T-Lymphocytes; D017809:Fatal Outcome; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006679:HIV Seropositivity; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis*; D008297:Male; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis* / Q000188:drug therapy; D009170:Nontuberculous Mycobacteria / Q000302:isolation & purification*; D013902:Radiography, Thoracic; D012514:Sarcoma, Kaposi / Q000175:diagnosis* / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents