A 55-year-old Caucasian man presents to the clinic with reddish purple nodules over the shin of both his legs. He was diagnosed to be HIV positive and has been on anti retroviral therapy since 6 months. He is homosexual and his boyfriend died of AIDS, two years ago. Biopsy of the lesion is ordered.

  1. The diagnosis in this case is
    1. Bacillary angiomatosis
    2. Hemangioma
    3. Dermatofibroma
    4. Kaposi’s Sarcoma

    Answer: The answer is (d). 

    Kaposis’s sarcoma is a common infection in HIV infected homosexual men. It is the most common HIV related malignancy. Kaposi’s sarcoma commonly involves the gastrointestinal tract, but in asymptomatic patients these lesions are not sought or treated.

  2. The following statements about the pathophysiology of this condition are true except:
    1. It is caused due to infection with Human Herpes virus 8
    2. It is the most common HIV associated malignancy
    3. The incidence of seropositivity to Human Herpes virus 8 correlates with the incidence of Kaposi’s sarcoma
    4. The Human Herpes virus 8 is present in the circulating T cells of infected persons

    Answer: The answer is (d).

    Human Herpesvirus 8 causes Kaposi’s sarcoma. It is the most common HIV associated malignancy. The incidence of seropositivity to Human Herpes virus 8 correlates directly to the incidence of Kaposi’s sarcoma. Human Herpes virus 8 is present in the skin lesions and circulating B-lymphocytes of persons with Kaposi’s sarcoma.

  3. Treatment of this condition includes all the following except
    1. Intralesional chemotherapy followed by radiation therapy
    2. Cryotherapy
    3. Intralesional vinblastine
    4. Surgical wide local excision

Answer: The answer is (d).

Surgical excision does not have a role in the treatment of Kaposi’s sarcoma. Intralesional chemotherapy might be sufficient in case of elderly persons. In AIDS associated Kaposi’s sarcoma it is important to give adequate anti-retroviral treatment. In most cases this alone would lead to regression of the tumor. For cosmetically objectionable lesions Intralesional vinblastine and cryotherapy can be tried.