4th Edition

Chapter 38: The purple spotted geek

A 42-year-old software engineer developed numerous pigmented skin lesions over a period of 6 months. He also noticed a purple lump on his hard palate. He then developed a cough and became short of breath, so he finally went to see his GP who sent him to A&E.

  • 1. What are the spots?

    Correct answer:
    Typical raised pigmented skin lesions of Kaposi’s sarcoma with involvement of the hard palate and conjunctiva.

  • 2. What blood test would you recommend?

    Correct answer:
    HIV serology

His HIV antibody test was positive and CD4 cell count was 34 /mm3 (7%) with a plasma HIV viral load of 256,000 copies/mL. He had a chest X-ray.

  • 3. What does the chest X-ray show?

    Correct answer:

    Reticular-nodular infiltrates more prominent in lower zones due to pulmonary Kaposi’s sarcoma.

He has a thoracic CT scan.

  • 4. What does the thoracic CT scan show?

    Correct answer:

    Reticular infiltrates and nodules characteristic of pulmonary Kaposi’s sarcoma.

He has a skin biopsy that confirms the diagnosis of Kaposi’s sarcoma.

  • 5. What virus causes Kaposi’s sarcoma?

    Correct answer:
    Kaposi’s sarcoma herpesvirus (KSHV) which is also known as human herpesvirus 8 (HHV8)

The diagnosis was confirmed as stage T1 I1 S0 AIDS-associated Kaposi’s sarcoma. He was treated with combination antiretroviral therapy, opportunistic infection prophylaxis and systemic liposomal anthracycline chemotherapy.

After 4 months his palate, conjunctiva and lungs were dramatically better and his CD4 count had risen to 58/mm3 and plasma HIV viral load was undetectable (<40 copies/mL).

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