| patients with the acquired immunodeficiency syndrome (AIDS) often have hypoalbuminemia. We report the case of a patient with AIDS in whom marked hypoalbuminemia developed due to a protein-losing enteropathy caused by small intestinal Kaposi's sarcoma--an entity not previously reported in AIDS. The patient presented with ankle edema, pleural effusions, and a decrease in albumin from 3.0 g/dL (30 g/L) to 1.7 g/dL (17 g/L) over one month. Protein-losing enteropathy was confirmed by a marked elevation in fecal alpha-1 antitrypsin, and extensive evaluation of the gastrointestinal tract revealed the source to be small intestinal Kaposi's sarcoma. A protein-losing enteropathy should be considered when hypoalbuminemia is encountered in a patient with AIDS. ( info) |
492/883. Pseudo-Kaposi's sarcoma as a complication of Cimino-Brescia arteriovenous fistulas in hemodialysis patients. Pseudo-Kaposi's sarcoma is a skin lesion that is associated with chronic venous insufficiency and/or congenital arteriovenous fistulas. Theoretically, this lesion could also be expected in connection with hemodialysis vascular accesses. Nevertheless, this disease has been reported only once in conjunction with a Cimino-Brescia arteriovenous fistula, and no attention has been paid to the potential complications of this disease. In the present paper 3 cases are reported. In 1 patient pseudo-Kaposi's sarcoma was complicated by an infected open wound as a consequence of a trauma. In the 2 other patients, a skin biopsy was followed by local infection and retarded healing of the wound. Evaluation by fistulagraphy and/or Doppler revealed venous outflow stenosis in only 1 case. After reconstruction or ligation of the fistula, correction of the lesions was observed. It is concluded that pseudo-Kaposi's sarcoma can occur as a complication of Cimino-Brescia arteriovenous fistulas, necessitating early correction of the fistula. The performance of a skin biopsy might be associated with infection and delayed wound healing, so that this diagnostic procedure should only be performed in cases where the clinical diagnosis is not obvious. ( info) |
493/883. Kaposi sarcoma in the acquired immune deficiency syndrome (AIDS), presenting as lymphogranuloma venereum (LGV) in a promiscuous trinidadian male. A 27-year-old promiscuous male who denied homosexuality, intravenous drug abuse or having received blood transfusions, had disseminated Kaposi sarcoma. The aggressive nature of the tumor in a young man with the Acquired Immune Deficiency Syndrome (AIDS) presenting as lymphogranuloma venereum (LGV) is highlighted. The relation of the HTLV III virus to a diffuse membranoproliferative glomerulonephritis with sclerosis and associated hyaline degenerative changes in the juxtaglomerular apparatus are discussed. ( info) |
494/883. Clinically uninvolved skin in AIDS: evidence of atypical dermal vessels similar to early lesions observed in Kaposi's sarcoma. Ultrastructural study in four patients. The clinically uninvolved skin of 4 patients with well-developed AIDS was investigated by electron microscopy. All biopsy specimens had vascular abnormalities: protruding endothelial cells, vascular channels reduced to slits, gaps within the vascular walls, and extravasated erythrocytes. These features are similar to those described in early lesions of Kaposi's sarcoma. These findings suggest that blood vessels of the clinically uninvolved skin of AIDS patients are potential sites of Kaposi's sarcoma lesions. ( info) |
495/883. Primary gastrointestinal Kaposi's sarcoma in a patient with acquired immune deficiency syndrome. Gastrointestinal involvement by Kaposi's sarcoma in patients with cutaneous or lymph node involvement is common. Since the advent of the acquired immune deficiency syndrome in 1981, primary gastrointestinal involvement, i.e., without skin or lymph node involvement, has not been adequately documented. We describe a patient with acquired immune deficiency syndrome and primary gastrointestinal involvement by Kaposi's sarcoma. ( info) |
496/883. Myogenic cells in Kaposi's sarcoma: an ultrastructural study. An ultrastructural study of a metastatic Kaposi's sarcoma in a cervical lymph node demonstrated the presence of endothelial cells, smooth muscle cells, fibroblasts and myofibroblasts. Some of these cells exhibited phagocytic activity in relation to extravasated red blood cells. The ultrastructural features favour the suggestion of an origin of Kaposi's sarcoma from pluripotential mesenchymal cells which may differentiate into more specialised cell types including endothelial, smooth muscle, fibroblastic and myofibroblastic cells. ( info) |
497/883. Primary Kaposi's sarcoma of an intraparotid lymph node with AIDS. A case of Kaposi's sarcoma of an intraparotid lymph node in a patient with previously undiagnosed AIDS is presented. In patients at risk for AIDS who present with undiagnosed head and neck tumors, the diagnosis of epidemic Kaposi's sarcoma should be considered. Although transmission of AIDS to health care workers is exceedingly rare, proper precautions should be exercised when working with these patients. ( info) |
498/883. Angioimmunoblastic lymphadenopathy following Kaposi's sarcoma. The close relationship of Kaposi's sarcoma (KS) with other lymphoproliferative disorders is a poorly understood, but well documented, phenomenon. A case is presented of a 68-year-old woman with the classical form of cutaneous KS in whom disappearance of the lesions after treatment was shortly followed by the development of angioimmunoblastic lymphadenopathy, pursuing a fulminant course to death. Postmortem examination revealed diffuse involvement of the marrow, spleen, liver, and lymph nodes by the immunoblastic proliferation. The close association of these two conditions may represent more than a chance occurrence. The appearance of a constellation of nonspecific symptoms suggestive of a lymphoproliferative disorder in debilitated patients with KS should alert the physician to the possibility of the development of this rare complication. ( info) |
499/883. AIDS related Kaposi's sarcoma presenting as ulcerative colitis and complicated by toxic megacolon. Gastrointestinal Kaposi's sarcoma is a well described and usually asymptomatic manifestation of the acquired immune deficiency syndrome. We report a patient who had extensive colonic Kaposi's sarcoma and presented with an ulcerative colitis like illness. Total colectomy was subsequently required as an emergency procedure for toxic megacolon. The patient remains well on maintenance interferon therapy 21 months after surgery. ( info) |
500/883. Simultaneous occurrence of Hodgkin's disease and Kaposi's sarcoma in a patient with the acquired immune deficiency syndrome. Kaposi's sarcoma and Hodgkin's disease have each been associated with abnormalities in T lymphocyte function and occur with increased frequency in the immunosuppressed host. Although the association of Kaposi's sarcoma with lymphoreticular disorders has long been recognized, only sporadic cases of Hodgkin's disease have been described in patients with the acquired immune deficiency syndrome (AIDS) in contrast to the frequent occurrence of non-Hodgkin's lymphoma in these patients. The simultaneous occurrence of Kaposi's sarcoma and Hodgkin's disease in the same lymph node is described in a patient with AIDS. This case suggests an association of AIDS with both Kaposi's sarcoma and malignant lymphomas and raises the question of a common pathogenetic mechanism. ( info) |