Iatrogenic Kaposi's Sarcoma: Hhv8 Positivity Persists But The Tumors Regress Almost Completely Without Immunosuppressive Therapy
Nagy, S., Gyulai, R., Kemeny, L., Szenohradszky, P., & Dobozy, A. (2000). Iatrogenic Kaposi's sarcoma: HHV8 positivity persists but the tumors regress almost completely without immunosuppressive therapy. Transplantation, 69(10), 2230–2231. https://doi.org/10.1097/00007890-200005270-00053
View Original Source →Abstract
Kaposi sarcoma-associated herpesvirus infection is associated with the development of 3 proliferative diseases: Kaposi sarcoma, primary effusion lymphoma, and multicentric Castleman disease. These conditions are also intimately associated with human immunodeficiency virus infection, and important synergistic interactions between these 2 viruses have been described. Despite differences in viral gene expression patterns in each condition, Kaposi sarcoma-associated herpesvirus encodes similar oncogenic proteins that promote the activation of sequential and parallel signaling pathways. Therapeutic strategies have been implemented to target these unique signaling pathways, and this sort of molecular targeting is the focus of many current research efforts. The scope of this review is to present contemporary knowledge about the epidemiology, virology, and immunology of Kaposi sarcoma-associated herpesvirus and to highlight several key oncogene products that may be targets for chemotherapy.
Case Details
Disease Location
Pretibial region on legs, left arm, mucuous membranes of pharynx, and right conjunctive, diagnosed as kaposi's sarcoma
Personal Characteristics
53-year-old caucasion male with end-stage renal disease
Clinical Characteristics
Had end-stage renal disease & underwent hemodialysis for 2 years before receiving a cadaver allograft kidney immunosuppressive therapy after transplant (prednisolone 30 mg/day & cyclosporine 400 mg/day)--> stabilized renal function 3 months later irregular blue-brown macules, nodules, plaques appeared on legs, arms--> clinical diagnosis of ks pcr using primers specific for hhv8(1) analyzed paraffin-embedded tissue hhv8 sequences detected in lesion from left pretibial region punch biopsy from regressed lesions on left arm upon disappearance of ks lesions--> histological examination revealed regressed ks
Remission Characteristics
2 months after grafectomy and hemodialysis and upon discontinuation of immunosuppressive therapy, repeat biopsy confirmed disappearance of ks lesions almost completely hhv8 viral DNA still detected
Treatment & Mechanisms
Proposed Remission Mechanisms
With restored immune function, hhv8 can be suppressed into latency
Clinical Treatment
Cyclosporine replaced by azathioprine (25 mg/day) and interferon (5 mu 3x/week) therapy 6 months later patient rejected transplant--> grafectomy and hemodialysis reintroduced and immunosuppressive medications discontinued