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Open Access Highly Accessed Case report

Brain localization of Kaposi’s sarcoma in a patient treated by combination antiretroviral therapy

Francesco Baldini1*, Andrea Baiocchini2, Vincenzo Schininà3, Chiara Agrati4, Maria Letizia Giancola1, Lucia Alba1, Susanna Grisetti1, Franca Del Nonno2, Maria Rosaria Capobianchi4 and Andrea Antinori1

Author Affiliations

1 Clinical Department, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, Via Portuense 292, 00149 Rome, Italy

2 Department of Pathology, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, Via Portuense 292, 00149 Rome, Italy

3 Diagnostic Department, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, Via Portuense 292, 00149 Rome, Italy

4 Laboratory of Virology, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, Via Portuense 292, 00149 Rome, Italy

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BMC Infectious Diseases 2013, 13:600  doi:10.1186/1471-2334-13-600

Published: 21 December 2013

Abstract

Background

Central nervous system is a very rare site of Kaposi’s sarcoma in acquired immunodeficiency syndrome. Kaposi’s sarcoma, a neoplasm of endothelial origin, occurs mainly in the skin, but can involve many tissues, especially in patients with a poor immunity. Combination antiretroviral therapy, highly active against human immunodeficiency virus type-1, has caused a dramatic reduction of cutaneous and visceral involvements. No report of central nervous system localization of Kaposi’s sarcoma is described since the introduction of combination antiretroviral therapy in the late 90’s.

Case presentation

A 42 year-old Caucasian man affected by human immunodeficiency virus type-1 infection treated with combination antiretroviral therapy and showing relatively preserved immunity with low viral load presented gingival squamous cell carcinoma and visceral (lungs and lymph nodes) Kaposi’s sarcoma. Chemotherapy and radiotherapy were performed with improvement of both neoplasms. Afterwards, a magnetic resonance imaging showed focal lesions of the brain. Despite new chemotherapy and radiotherapy the patient died. Histology after autopsy revealed brain lesions due to Kaposi’s sarcoma with the detection of Human Herpesvirus 8 on tissue samples.

Conclusions

This is the first report in the combination antiretroviral therapy era of a very rare complication of Kaposi’s sarcoma, such as that of brain localization, in a patient with a relatively good control of human immunodeficiency virus infection. Therefore, Kaposi’s sarcoma should be considered in differential diagnosis with other intracranial mass lesions that can occur in human immunodeficiency virus infected-patients focusing the issue of appropriate treatment for central nervous system involvement.

Keywords:
Kaposi’s sarcoma; HHV-8; HIV; Combination antiretroviral therapy; Central nervous system