title: Steroid-exacerbated HIV-associated cutaneous Kaposi's sarcoma immune reconstitution inflammatory syndrome: 'Where a good intention turns bad'.
abstract: A 51-year-old man with head and neck skin lesions was diagnosed with Kaposi's sarcoma (KS) as his initial presentation of acquired immunodeficiency syndrome. Following initiation of antiretroviral therapy and subsequent full virologic suppression, his facial lesions worsened, consistent with immune reconstitution inflammatory syndrome (IRIS). He was started on glucocorticoids in an attempt to ameliorate the KS-IRIS but experienced paradoxical worsening of the KS lesions. Steroids were subsequently discontinued and he required chemotherapy for severe and cosmetically disfiguring skin lesions. This article describes the potential for worsening of KS lesions in individuals started on glucocorticoids for KS-IRIS as this has been reported rarely in published literature. The mechanisms underlying this phenomenon remain poorly understood but potential explanations are offered in the case discussion. This article aims to raise clinician awareness on the harms of steroid use in patients with KS-IRIS.
authors.affiliation: Department of Medicine, Waterbury Hospital, Waterbury, CT, USA.
authors.forename: Shiven
authors.initials: S
authors.lastname: Chabria
authors.affiliation: Yale AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Lydia
authors.initials: L
authors.lastname: Barakat
authors.affiliation: Yale AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA onyema.ogbuagu@yale.edu.
authors.forename: Onyema
authors.initials: O
authors.lastname: Ogbuagu
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000276:immunology; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy*; D023241:Antiretroviral Therapy, Highly Active; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012514:Sarcoma, Kaposi / Q000150:complications* / Q000276:immunology / Q000473:pathology; D012867:Skin / Q000473:pathology; D013256:Steroids / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D013256:Steroids
keywords: AIDS; HIV; IRIS; Kaposi’s sarcoma; opportunistic infection; steroids