Kaposi Sarcoma with Musculoskeletal Manifestations in a Well-controlled HIV Patient

We present here a case of relapsed HIV-related Kaposi Sarcoma (KS), manifesting as a plantar ulcer with underlying bone involvement in a patient with well-controlled HIV. Radiographic and magnetic resonance imaging of the patient’s right foot showed bone destruction suggestive of osteomyelitis. However, when a bone biopsy was done, this was consistent with KS, without any signs of bone infection. Patient was initially diagnosed with KS four years prior. He was successfully treated at the time with doxorubicin, radiation therapy, and began HIV therapy. At the time of the KS recurrence, his HIV viral load was undetectable and his CD4 count was over 900 cells/uL (CD4 percentage of 42%).Musculoskeletal (MSK) involvement in KS is a rare manifestation of this disease. The argest series of skeletal KS in people living with HIV by Papanastasopoulos at el. showed a prevalence of only 1.1%. The radiological features of MSK-KS are generally lytic osseous lesions, but presentations may differ. Bone biopsy remains the gold standard for diagnosis, as many other infectious and neoplastic processes can mimic MSK-KS radiographically.In the era of highly active antiretroviral therapy, people living with HIV who are diagnosed with MSK-KS appear to have a substantially improved survival rate than previously described.
Source: IDCases - Category: Infectious Diseases Source Type: research

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CONCLUSIONS: This study has highlighted that infection is frequently clinically indistinguishable from sarcoma and remains a principle non-neoplastic differential diagnosis. When patients are investigated for suspected sarcoma, infections can be missed due to falsely negative radiological investigations and percutaneous biopsy. As no single clinical, biochemical or radiological feature or investigation can be relied upon for diagnosis, clinicians should have a low threshold for tissue biopsy and discussion in a sarcoma multidisciplinary team meeting. PMID: 31155889 [PubMed - as supplied by publisher]
Source: Annals of the Royal College of Surgeons of England - Category: Surgery Authors: Tags: Ann R Coll Surg Engl Source Type: research
1170Objectives: Ewing sarcoma, a rare tumor of neuroectodermal origin, arising from bone or soft tissue typically affects children and young adults and is one of the tumors bearing extremely poor prognosis. Since the prognosis heavily depends on initial staging, accurate staging of the tumor at diagnosis is of paramount importance. Conventional imaging such as CT and MRI and skeletal scintigraphy are some of the standard diagnostic tests employed for disease staging. 18F-FDG PET/CT, presently an optional diagnostic modality in Ewing sarcoma has the advantage of whole-body scanning and the combination of functional and anat...
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Pediatrics Posters Source Type: research
Abstract Small round cell lesions of the bone encompass a heterogeneous group of tumors and tumor-like lesions, including Ewing sarcoma, small cell osteosarcoma, mesenchymal chondrosarcoma, neuroblastoma, non-Hodgkin's lymphoma (NHL), "Ewing-like" undifferentiated round cell sarcomas, metastasizing small cell carcinoma, along with plasma cell dyscrasia and Langerhan's cell histiocytosis. At the same time, there are tumor mimics, for example, chronic osteomyelitis, which has overlapping radiologic features with Ewing sarcoma and a primary intraosseous NHL. An exact diagnosis necessitates integration of cl...
Source: Indian Journal of Pathology and Microbiology - Category: Pathology Authors: Tags: Indian J Pathol Microbiol Source Type: research
ConclusionThe particularity of this observation is the bilaterality of the lesion on both forearms and it has not previously been reported. Langerhans cell histiocytosis should be included in the differential diagnosis of osteomyelitis and Ewing ’s sarcoma.
Source: Journal of Medical Case Reports - Category: General Medicine Source Type: research
ConclusionA stable fixation may lead to a good bone healing despite an extensive wound dehiscence and a wide plate and screws exposure with just a proper local wound care and without any major additional surgery.Level of evidenceLevel IV.
Source: Orthopaedics and Traumatology: Surgery and Research - Category: Orthopaedics Source Type: research
This article describes the case of an 11-month-old boy with claudication, right lower limb shortening, and painless right leg volume increase. Image studies demonstrated an osteolytic lesion with small ossifications within, involved by right tibial diaphysis cortical thickening. The diagnostic hypotheses were osteoid osteoma, chronic osteomyelitis (Brodie's abscess), Ewing sarcoma, and Langerhans cell histiocytosis. Microorganism cultures were negative and the histopathological exam demonstrated osteoid osteoma. This report expands the knowledge on osteoid osteoma as a cause of painless limping and lower limb shortening in...
Source: Revista Brasileira de Ortopedia - Category: Orthopaedics Source Type: research
Publication date: 2018Source: IDCases, Volume 12Author(s): Ehab Saad Aldin, Poorani Sekar, Zein Saad Eddin, Jaclyn Keller, Janet PollardAbstractAn 83-year old man presented acutely to the emergency department with generalized weakness and subjective fevers. A month earlier he had undergone resection of a large intramuscular sarcoma from his thigh. The cancer staging work-up was still underway and a decision about adjuvant therapy was still pending. Although initial laboratory assessment showed leukocytosis, this normalized soon after admission without the use of antimicrobials. No fevers were documented. During the admissi...
Source: IDCases - Category: Infectious Diseases Source Type: research
This article describes the case of an 11-month-old boy with claudication, right lower limb shortening, and painless right leg volume increase. Image studies demonstrated an osteolytic lesion with small ossifications within, involved by right tibial diaphysis cortical thickening. The diagnostic hypotheses were osteoid osteoma, chronic osteomyelitis (Brodie's abscess), Ewing sarcoma, and Langerhans cell histiocytosis. Microorganism cultures were negative and the histopathological exam demonstrated osteoid osteoma. This report expands the knowledge on osteoid osteoma as a cause of painless limping and lower limb shortening in...
Source: Revista Brasileira de Ortopedia - Category: Orthopaedics Source Type: research
Publication date: 2018Source: IDCases, Volume 12Author(s): Ehab Saad Aldin, Poorani Sekar, Zein Saad Eddin, Jaclyn Keller, Janet PollardAbstractAn 83-year old man presented acutely to the emergency department with generalized weakness and subjective fevers. A month earlier he had undergone resection of a large intramuscular sarcoma from his thigh. The cancer staging work-up was still underway and a decision about adjuvant therapy was still pending. Although initial laboratory assessment showed leukocytosis, this normalized soon after admission without the use of antimicrobials. No fevers were documented. During the admissi...
Source: IDCases - Category: Infectious Diseases Source Type: research
In January, 2018, Academic Press published my bookPrecision Medicine and the Reinvention of Human Disease. This book has an excellent " look inside " at itsGoogle book site, which includes the Table of Contents. In addition, I thought it might be helpful to see the topics listed in the Book's index. Note that page numbers followed by f indicate figures, t indicate tables, and ge indicate glossary terms.AAbandonware, 270, 310geAb initio, 34, 48ge, 108geABL (abelson leukemia) gene, 28, 58ge, 95 –97Absidia corymbifera, 218Acanthameoba, 213Acanthosis nigricans, 144geAchondroplasia, 74, 143ge, 354geAcne, 54ge, 1...
Source: Specified Life - Category: Information Technology Tags: index jules berman jules j berman precision medicine Source Type: blogs
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