gms | German Medical Science

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010)

Deutsche Gesellschaft für Infektiologie,
Deutsche AIDS-Gesellschaft,
Deutsche Gesellschaft für Tropenmedizin und Internationale Gesundheit,
Paul-Ehrlich-Gesellschaft für Chemotherapie

23.06. - 26.06.2010, Köln

New osteolytic lesions in an AIDS patient with Kaposi sarcoma

Neu aufgetretene Osteolysen bei einem AIDS-Patienten mit Kaposi Sarkom

Meeting Abstract

  • J. Thoden - Universitätsklinikum Freiburg, Centrum für Chronische Immundefizienz – CCI, Freiburg, Germany; Universitätsklinikum Freiburg, Rheumatologie und Klin. Immunologie, Freiburg, Germany
  • N. Venhoff - Universitätsklinikum Freiburg, Centrum für Chronische Immundefizienz – CCI, Freiburg, Germany; Universitätsklinikum Freiburg, Rheumatologie und Klin. Immunologie, Freiburg, Germany
  • S. Usadel - Praxis Usadel, Freiburg, Germany; Centrum für Chronische Immundefizienz – CCI, Freiburg, Germany
  • K. Warnatz - Universitätsklinikum Freiburg, Centrum für Chronische Immundefizienz – CCI, Freiburg, Germany; Universitätsklinikum Freiburg, Rheumatologie und Klin. Immunologie, Freiburg, Germany
  • D. Wagner - Universitätsklinikum Freiburg, Centrum für Chronische Immundefizienz – CCI, Freiburg, Germany; Universitätsklinikum Freiburg, Zentrum für Infektiologie und Reisemedizin, Freiburg, Germany
  • M. Uhl - Diagnostische und Interventionelle Radiologie und Kinderradiologie, St. Josefs-Krankenhaus Freiburg, Freiburg, Germany
  • W.V. Kern - Universitätsklinikum Freiburg, Centrum für Chronische Immundefizienz – CCI, Freiburg, Germany; Universitätsklinikum Freiburg, Zentrum für Infektiologie und Reisemedizin, Freiburg, Germany

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010). Köln, 23.-26.06.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP114

DOI: 10.3205/10kit169, URN: urn:nbn:de:0183-10kit1691

Published: June 2, 2010

© 2010 Thoden et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Introduction: Differential diagnosis of rare described osseous lesions in HIV-patients includes bacillary angiomatosis (BA), multiple myeloma (MM) and seldom Kaposi sarcoma (KS) (Caponetti et al. Cancer. 2007;109:1040). KS is associated with HHV8 infection and has a low-grade malignant potential. It mainly manifests in mucocutaneous sites, but can involve lymph nodes and visceral organs. Most osseous KS lesions are osteolytic and can lead to complete bone destruction (Pantanowitz et al. BMC Cancer 2008; 8:190).

Case report: The patient, a 45 yo man with a ten-year history of HIV (CDC C3), presented with dyspnea after ART interruption (CD4 28/µl, 2.2%; VL 300 c/ml). A thoracic CT scan showed typical PjP infiltrates, high-dose cotrimoxazole was given and ART was restarted. At the same time he had developed new KS of skin and oral mucosa (Figure 1a [Fig. 1]), KS treatment was refused. After 5 months with persisting dyspnea a follow-up CT-scan showed new osteolytic lesions of the whole spine (Figure 1b [Fig. 1]), X-ray imaging showed involvement of pelvis, hip and femur (Figure 1c [Fig. 1]). There were no signs of MM (no monoclonal gammopathy) or bacillary angiomatosis (stable B. henselae IgG-titer and negative PCR), serum HHV8-PCR however was positive. A biopsy (Figure 1d [Fig. 1]) to confirm KS-associated bone lesions only showed an unspecific cyst. Liposomal doxorubicin (L-Dox) was started with consequtive improvement of skin lesions. Follow-up CT-scans after four months and 10 cycles of L-Dox showed sclerosis of the prevoiusly osteolytic lesions, which was interpreted as treatment response. During the course of KS therapy the patient remained incompliant in respect to ART and was immunologically and virologically poorly controlled.

Conclusions: Osteolytic lesions are rare in HIV-patients. KS has to be suspected if mucocutaneous lesions are present. Differential diagnoses such as MM and BA need to be ruled out, histology can confirm the diagnosis. Despite poor adherence to ART progress of osseous KS can be prevented by L-Dox therapy. Adherence to ART would allow long-term success. If unstable osteolysis develops surgery or radiation will be alternative treatment options.