Generalized Kaposi’s Sarcoma in an HIV Negative Patient: Case Report

Abstract

BACKGROUND: Kaposi’s Sarcoma is a vascular neoplasm associated with human herpesvirus 8 (HHV-8). It typically manifests with cutaneous lesions but can also involve extracutaneous sites such as mucous membranes, lymph nodes and visceral organs. Kaposi’s Sarcoma is classified in 4 major subtypes: classic, epidemic, endemic and iatrogenic. The classic form usually follows a slow course, with progressions of cutaneous lesions over more than 10-15 years. However atypical cases of this form have been described in the literature. We aimed to present an atypical case of generalized Kaposi’s Sarcoma in an HIV negative patient.

CASE REPORT: We report an atypical case of Kaposi’s Sarcoma (KS) classic type, in a 62-year-old HIV-negative male, notable for its unusual cutaneous presentation, distribution, and rapid progression. The patient presented to the Emergency Department with asymptomatic violet-to-red cutaneous lesions, including both plaques and nodules, distributed across the upper and lower extremities, abdomen, and back. The lesions first appeared approximately eight months prior but demonstrated a fulminant course in the weeks leading up to presentation, with rapid dissemination. Initial home management of the patient included local and oral folk remedies of unknown composition. A skin biopsy performed during hospitalization revealed nodular Kaposi’s Sarcoma, and immunohistochemistry (IHC) was recommended for diagnostic confirmation. HIV serology was negative, and imaging, including lymph node ultrasound, revealed no evidence of visceral involvement.

CONCLUSIONS: This case illustrates an atypical presentation of classic Kaposi Sarcoma (KS) in an immunocompetent, HIV-negative patient, characterized by rapid progression and diffuse cutaneous involvement. Such a clinical course is uncommon for the classic subtype, which is typically indolent and slowly progressive. Our findings support the growing body of evidence that subgroups within classic KS may exhibit distinct clinical behaviors, requiring tailored staging and management strategies. Given the absence of any known immunosuppressive conditions or identifiable triggers, further research is needed to elucidate the underlying pathophysiological mechanisms in atypical cases of classic KS.