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Case report
Diagnostic and management considerations in the modern patient with AIDS: a case of concurrent disseminated Kaposi sarcoma and colesional Cryptococcus neoformans
  1. Samuel Clay Williams1,
  2. Jacob Sweeney2 and
  3. Lalitha Parameswaran3
  1. 1Tri-Institutional MD PhD Program, Weill Cornell Medical College, New York, New York, USA
  2. 2Weill Cornell Medicine Department of Pathology and Laboratory Medicine, New York, New York, USA
  3. 3Department of Medicine, NYU Langone Medical Center, New York, New York, USA
  1. Correspondence to Mr Samuel Clay Williams; scw2008{at}med.cornell.edu

Abstract

In the era of highly active antiretroviral therapy (HAART), disseminated Kaposi sarcoma (KS) has become much rarer in the USA. We report a case of a 34-year-old man with KS of the skin, oropharynx, lung and rectum. Within the same lung nodule, we discovered significant burden of colesional Cryptococcus neoformans, in the context of a positive asymptomatic cryptococcal antigenemia, which was a previously unreported occurrence. The gold standard of treatment for KS continues to be HAART. The role of chemotherapy is still controversial. In addition, a cryptococcal antigen screen-and-treat approach with fluconazole is still not routinely recommended in the USA to prevent serious meningeal disease despite recent studies showing efficacy and applicability. We discuss both issues here and the outcome of our patient. We also present the patient’s own unique perspective in dealing with the ramifications of these diagnoses.

  • infectious diseases
  • HIV / AIDS
  • drugs: infectious diseases
  • Cryptococcus
  • skin cancer
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Footnotes

  • Contributors SCW wrote, compiled and edited the manuscript as well as assisted in care. JS provided Pathology expertise, images of biopsies and editing of the manuscript. LP was the primary physician for the patient’s care, as well as assisted in writing and editing the manuscript.

  • Funding This study was funded by National Institute of General Medical Sciences (grant number T32GM007739).

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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