Pulmonary Disease

	Answer 4 HHV-8. This patient has Kaposi sarcoma (KS), an angioproliferative tumor associated with HHV-8. AIDS-related KS has a variable course ranging from an incidental finding to rapidly progressive disease, resulting in significant morbidity and mortality. Typically, tumors involve the skin and lymph nodes, although visceral organs may also be involved. Dermatologic manifestations often appear on the lower extremities, face, oral mucosa, and genitalia and may be papular, plaque-like, or exophytic and fungating. Pulmonary involvement is common in AIDS-related KS. Dyspnea and cough are the most common presenting symptoms; hemoptysis may also occur. A plain chest radiograph shows nodular thickening along the peribronchovascular bundles often radiating from the hila (Figure 2). As pulmonary lesions progress, nodules become confluent and irregular, which may lead to dense air-space consolidation. KS is a highly vascular tumor and biopsy is associated with a significant incidence of hemorrhage.5 Alveolar hemorrhage may also be associated with KS, although this is a nonspecific finding. The incidence of cutaneous tuberculosis is low and is not likely the cause of this patient’s symptoms. P. jiroveci may also be associated with skin lesions but most commonly involves the skin around the external auditory canal and nasal passages. Clinically, skin lesions related to PCP appear similar to molluscum contagiosum. Epstein-Barr virus in HIV-infected patients has been associated with non-Hodgkin’s lymphoma and oral hairy leukoplakia. REFERENCE 5. Aboulafia D. The epidemiologic, pathologic, and clinical features of AIDS-associated pulmonary Kaposi’s sarcoma. Chest 2000;117:1128–45. Click here to return to the questions
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