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For further information, see CMDT Part 6-13: Kaposi Sarcoma
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Essentials of Diagnosis
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General Considerations
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Occurs in five forms
Classic Kaposi sarcoma occurs in older men, has a chronic clinical course, and is rarely fatal
Endemic Kaposi sarcoma is an often aggressive form that occurs in young Black men of equatorial Africa
Iatrogenic Kaposi sarcoma occurs from immunosuppressive therapy
Epidemic Kaposi sarcoma is associated with HIV-associated immune deficiency
Incidence is diminishing
Can develop in patients with HIV infection, high CD4 counts, and low viral loads
Usually resembles the endemic form, being indolent and localized
Can be clinically aggressive
The presence of Kaposi sarcoma at the time of antiretroviral initiation is associated with Kaposi sarcoma–immune reconstitution inflammatory syndrome, which has an especially aggressive course in patients with visceral disease
Indolent Kaposi sarcoma occurs exclusively in men without HIV who have sex with men
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Red, purple, or dark plaques or nodules on cutaneous or mucosal surfaces
Marked edema may occur with few or no skin lesions
Commonly involves the gastrointestinal tract, but in asymptomatic patients these lesions are not sought or treated
Pulmonary Kaposi sarcoma
Can present with shortness of breath, cough, hemoptysis, or chest pain
May be asymptomatic, appearing only on chest radiograph
Chronic Kaposi sarcoma
Can develop in patients with HIV infection, high CD4 counts, and low viral loads
Usually resembles the endemic form, being indolent and localized
However, it can be clinically aggressive
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Differential Diagnosis
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Diagnostic Procedures
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Kaposi sarcoma in older patients
In the setting of iatrogenic immunosuppression
AIDS-associated Kaposi
The patient should first be given effective anti-HIV antiretrovirals
Intralesional vinblastine (0.1–0.5 mg/mL) for cosmetically objectionable lesions
Systemic therapy is indicated in patients with skin disease that is cosmetically unacceptable or in those with advanced cutaneous, oral visceral, or nodal disease
Antiretroviral therapy plus chemotherapy appears to be ...