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Kaposi Sarcoma — SCE Infectious Diseases MCQ

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HardImmunocompromised HostKaposi SarcomaSCE Infectious Diseases

A 50-year-old kidney transplant recipient 8 years post-transplant presents with multiple violaceous papulonodular skin lesions on the lower limbs. Biopsy shows spindle cells with slit-like vascular spaces positive for HHV-8 on immunohistochemistry. What is the diagnosis and initial management approach?

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Correct answer: C — Kaposi sarcoma; reduce immunosuppression and consider switch from Ciclosporin to Sirolimus

HHV-8 (KSHV) positive spindle cell lesions with slit-like vascular spaces in a transplant recipient are diagnostic of Kaposi sarcoma (KS). The first management step is reduction of immunosuppression. Switching from calcineurin inhibitors (Ciclosporin/Tacrolimus) to mTOR inhibitors (Sirolimus/Everolimus) has anti-angiogenic and anti-tumour properties beneficial in transplant-associated KS. Chemotherapy (liposomal Doxorubicin) is reserved for extensive or visceral disease.

Reference: NICE 2023 – Post-transplant malignancy; BTS 2024 – Post-transplant guidelines