title: A case report of immunosuppression-related Kaposi's sarcoma after autologous stem cell transplantation.
abstract: BACKGROUND
  Kaposi's sarcoma (KS) is a tumor formed by angioproliferations driven by Human herpes virus 8 also known as Kaposi's sarcoma-associated herpes virus (KSHV). It is best known as an acquired immune deficiency syndrome (AIDS) defining illness that may be fatal. There are only a few reports of KS after hematopoietic cell transplantation (HCT). This is the first case describing the disappearance of KS with immune recovery after autologous HCT.
  
  
  METHODS
  We present the case of a 61-year-old male heterosexual patient of Moroccan origin treated for primary mediastinal non-Hodgkin lymphoma. Because of refractory disease he received multiple lines of chemotherapy prior to autologous HCT. After the second course of low-dose bis-chloroethylnitrosourea, etoposide, cytarabine, melphalan (BEAM) the patient developed several round blue skin lesions. A biopsy was performed, showing many small vessels and positive immune histochemical staining for Human herpes virus 8 (HHV-8), confirming diagnosis of KS. Human immunodeficiency virus testing was negative and work-up showed that there were no visceral lesions. When KS are limited to the skin, prognosis is usually better. The extensive chemotherapy resulted in an important immunosuppression; on day 105 after autologous HCT CD4(+) count was 82/mm(3). Since KS were limited to the skin and attributed to severe immune suppression a watchful waiting strategy was adopted even though in the first months after autologous HCT new skin lesions appeared. With immune recovery (CD4(+) count > 200/mm(3)) 277 days after transplant, skin lesions faded.
  
  
  CONCLUSIONS
  Kaposi's sarcoma remains a rare tumor that should be thought of in any patient whose immunity is down. If immune recovery is expected and disease is limited to the skin, a watchful waiting strategy can be more rewarding than intensive chemotherapy.
authors.affiliation: Department of Clinical Hematology, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Jette-Brussels, Belgium. bert.heyrman@uzbrussel.be.
authors.forename: Bert
authors.identifier: http://orcid.org/0000-0002-3900-4426
authors.initials: B
authors.lastname: Heyrman
authors.affiliation: Department of Clinical Hematology, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Jette-Brussels, Belgium.
authors.forename: Ann
authors.initials: A
authors.lastname: De Becker
authors.affiliation: Department of Clinical Hematology, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Jette-Brussels, Belgium.
authors.forename: Rik
authors.initials: R
authors.lastname: Schots
mesh_terms: D004727:Endothelium / Q000473:pathology; D019288:Herpesvirus 8, Human / Q000502:physiology; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012514:Sarcoma, Kaposi / Q000209:etiology* / Q000628:therapy* / Q000821:virology; D012867:Skin / Q000473:pathology; D033581:Stem Cell Transplantation; D014182:Transplantation, Autologous
keywords: Autologous stem cell transplantation; Kaposi’s sarcoma