Conjuntival Kaposi's Sarcoma Establishes Aids Diagnosis

To report a case of Kaposi sarcoma in a patient with previously undiagnosed Human Immunodeficiency Virus (HIV) infection.

Kaposi sarcoma is a vascular spindle cell tumor of endothelial cell origin which can present in the skin, viscera, or mucosa. Although classic Kaposi sarcoma is considered an indolent disease, the epidemic or AIDS-associated form tends to be more aggressive. With the advent of highly active antiretroviral therapy (HAART) the incidence has declined dramatically. However, as with most cancers the prognosis of AIDS-associated Kaposi Sarcoma is highly dependent on the timing of diagnosis.

A 25-year-old male patient with no significant pathological personal history. He attended a general ophthalmological examination, reporting a lesion in the left eye of 3 weeks evolution and also a lesion in the left forearm at the same time. The patient referred having risky sexual activities and tattoos on both arms and back 3 years ago.

On ophthalmological examination: visual acuity of 20/20 and 20/25 in his right and left eye respectively. The left eye lesion is a violaceous, exophytic lesion in the inferior temporal quadrant of the conjunctiva. The remainder of the examination for both eyes was normal.  The forearm lesion shows an exophytic form with a nodular appearance.

Due to the clinical appearance, Kaposi's sarcoma was suspected. Tests for HIV reported a viral load of 551,958 copies and the CD4+ count was 74 cells/uL. An excisional biopsy of the lesion in the left eye was performed, where neoplastic cells, high mitotic activity and vascular channels surrounded with erythrocytes were reported, likewise immunohistochemistry was performed where cells infected by herpes virus 8 were identified. Antiretroviral therapy was started and the patient was sent to an HIV clinic for follow-up and systemic control.

Ocular involvement of Kaposi sarcoma as the initial manifestation of HIV/AIDS is rare with only a few reported cases. Now a days, due to the introduction of highly active antiretroviral therapy (HAART), conjunctival Kaposi's sarcoma is less frequently observed. Concern for Kaposi sarcoma of the conjunctiva in this patient led to the evaluation for HIV/AIDS. It is vital for all healthcare providers to have Kaposi sarcoma in the differential diagnosis of a hemorrhagic conjunctival or adnexal mass and be familiar with its association with HIV/AIDS. If suspected, appropriate counseling and testing should be performed.