A 36-year-old immunocompetent man who have sex with men first presented to the plastics team with an ulcerating lesion on his left first toe. The lesion was suggestive of pyogenic granuloma (PG) clinically and histologically. Two years later, the same patient presented to the dermatology clinic with a new erythematous lesion with intermittent bleeding on the left second toe. Clinically, this lesion was suggestive of another PG. However, the histology of the skin curettage revealed part of a PG merging with an atypical spindle cell proliferation with characteristic ‘sieve-like’ appearance in keeping with Kaposi sarcoma. This was confirmed with human herpesvirus-8 immunohistochemistry staining. PG-like Kaposi sarcoma is an uncommon variant of Kaposi sarcoma. Often not considered clinically or histologically, a deep skin biopsy is essential to establish the right diagnosis. Our case highlights the need to consider Kaposi sarcoma as a differential diagnosis in all patients, including HIV-negative individuals, presenting with PG-like lesions.
- infectious diseases
- skin cancer
- sexual health
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Contributors Supervised by SS. Patient was under the care of IK. Report was written by BH, GR and SS.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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