KAPOSI SARCOMA: A RARE CAUSE OF UNILATERAL FOOT PAIN IN A SOLID ORGAN TRANSPLANT RECIPIENT
Dr Siaw Wee Teo1, Dr Sally Zou1, Dr Ian Simpson2, Dr Jessica Ryan1,3, Prof John Kanellis1,3, Dr Joanna Kent1,3, A/Prof William Mulley1,3
1Department of Nephrology, Monash Medical Centre, Clayton, Australia, 2Department of Anatomical Pathology, Monash Medical Centre, Clayton, Australia, 3Department of Medicine, Monash Medical Centre, Clayton, Australia
Background: A 65 year old Sudanese man with sequential liver and kidney transplants presented with severe unilateral foot pain and swelling.
Case Report: The patient presented with 3 weeks of severe pain and swelling of his left midfoot and fourth digit, with associated hyperpigmentation over the plantar aspect. His past history included kidney failure due to primary membranous nephropathy, and liver cirrhosis due to hepatitis B and schistosomiasis infection. He underwent kidney and liver transplantation 5 and 7 years ago respectively, and his immunosuppression consisted of tacrolimus, mycophenolate and prednisolone. His medical history included hypertension, diabetes, dyslipidaemia, gastroesophageal reflux, as well as treated latent tuberculosis, syphilis, herpes simplex and cytomegalovirus infections. Examination showed hyperpigmented lesions on the sole of his foot.
Magnetic resonance imaging of his left lower limb demonstrated soft tissue swelling over the fourth distal interphalangeal joint and dorsum of the midfoot. Inflammatory markers were normal. He was trialled on antibiotics and high dose oral corticosteroids for presumed cellulitis and gout, respectively, with minimal effect.
Over 4 weeks, the patient’s skin changes evolved into hyperpigmented plaques. A skin biopsy revealed a diagnosis of Kaposi sarcoma (KS).
Treatment with sirolimus was instituted and immunosuppression reduced, with some symptomatic improvement.
Conclusions: KS is an uncommon cancer with a prevalence of 0.21% in the Australian renal transplant population, resulting from angiogenic proliferation of endothelial cells driven by human herpesvirus 8 (HHV8) infection, and can develop in immunosuppressed patients from areas of high HHV8 seroprevalence. Skin changes of KS may be subtle in patients with darker skin pigmentation, therefore increased awareness of this condition is important in immunosuppressed transplant patients from HHV8 endemic areas.
Biography:
Siaw Wee is a first year Advanced Trainee at Monash Medical Centre.