Abstract

We report the first case of AIDS-associated Kaposi's Sarcoma in a 35 year old Indian female, a commercial sex worker, with lesions involving skin and mucous membranes. Diagnosis was confirmed on histopathology, electron microscopy, seropositivity, (ELISA and Western Blot) as well as Pepti-LAV test and viral culture. Antibodies to human immunodeficiency virus, both HIV-1 & 2, were present. HLA DR5,7 was positive on oligotyping. Genetic predisposition, therefore, may be suspected.

PIP: Kaposi's sarcoma (KS) is a neoplasm of multifocal origin which manifests primarily as multiple vascular nodules in the skin and other organs. Its association with HIV has been reported in America, Africa, and Europe. Extremely rare in HIV-infected women and children, the condition is reported more commonly in homosexual males. It is suspected that female hormones may protect women against KS. The first case of AIDS-associated KS in a 35-year old Indian female prostitute is reported for its rarity and clinico-epidemiological implications in the Indian setting. The woman presented with multiple painless non-pruritic nodules of varying colors on the right leg with swelling since two months. There was no history of trauma, discharge from the lesions or any treatment taken, nor any history of blood transfusion, IV drug use, or sexually transmitted disease. On examination, present mainly on the right leg were multiple, nontender papulonodules, reddish to purplish in color, 2-10 mm in diameter, and adherent to skin and underlying structures but not to the bone. Few discrete similar lesions were seen on the right forearm and left side of chin and left leg. Telangiectasia was noted on the anteromedial part of the right knee and ears and molluscum contagiosa on the front of the chest, while bilateral non-pitting oedema was apparent up to the knee. Inguinal and supraclavicular lymph glands were palpable. A raised purplish plaque was seen on the hard palate and in front of the left upper lateral incisor on the gingiva with candidiasis of the dorsum of the tongue, and there was congestion of the right lower palpebral conjunctiva, while a systemic examination proved normal. The diagnosis of KS was confirmed by histopathology, electron microscopy, seropositivity, and Pepti-LAV test and viral culture. Antibodies were found to HIV-1 and HIV-2, and HLA DR5,7 was positive on oligotyping. On treatment, initially, very few skin lesions flattened almost totally after intralesional injection of vincrysticine. Alpha interferon 200 IU sublingually daily showed amelioration in palatal, gingival, chin, forearm, and right leg lesions within a fortnight. The patient is receiving tab ketoconazole orally, 200 mg bid for oral and esophageal candidiasis and tab cimetidine as an immunomodulator. Since cutaneous lesions of KS are radiosensitive, local radiotherapy for leg lesions is contemplated.