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Kaposi Sarcoma HIV — ORE Part 1 MCQ

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HardOral MedicineKaposi Sarcoma HIVORE Part 1

A patient with well-controlled HIV on antiretroviral therapy presents with a painless, purple, flat macule on the hard palate. What is the most likely diagnosis?

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Correct answer: DKaposi sarcoma

The painless purple flat macule on the hard palate in an HIV-positive patient is pathognomonic for Kaposi sarcoma (KS). The hard palate is the most common intraoral site (46.8% of oral KS cases), and purple discoloration appears in over half of presentations. Although risk is highest with CD4 <200 cells/mm³, oral KS can occur despite immune reconstitution if HHV-8 co-infection is present. Amalgam tattoo appears blue-grey and is associated with dental restorations. Melanoma presents as brown or black and lacks the vascular character of KS. Racial pigmentation is brown and benign. Traumatic haematoma would be tender, painful, or resolving—never painless on initial presentation.

Reference: Oral Kaposi sarcoma development is associated with HIV viral load, CD4+ count and CD4+/CD8+ ratio. NCBI/PMC 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8601642/; Kaposi's sarcoma of the palate in a patient with AIDS: an unusual presentation. PubMed 1992. https://pubmed.ncbi.nlm.nih.gov/2730424/