A Case of Kaposi Sarcoma and Castleman Disease in a Young Male with New-Onset HIV

Abstract

Kaposi sarcoma is an AIDS-defining illness associated with HHV-8 infection that is caused by the malignant proliferation of endothelial cells in blood and lymphatic vessels. Castleman disease is a rare, lymphoproliferative disease identified by specific histopathologic features of the lymph nodes following biopsy. An association between Castleman disease and Kaposi sarcoma is poorly described, and there are a limited number of cases in the literaturepresenting patients with both conditions simultaneously. Thus, we present a case of a young male with newly diagnosed HIV that tested positive for HHV-8 and presented with both Kaposi sarcoma and multicentric Castleman disease. A 22-year-old African American male presented to the ED with a one-week history of sore throat, fever, fatigue, diffuse cervical lymph node enlargement, and night sweats. Initial workup indicated that the patient was positive for Epstein- Barr virus and HIV, with an initial CD4 count of 141. CT of the neck revealed extensive cervical adenopathy and abdominal CT revealed splenomegaly. These findings raised suspicion for lymphoma, and bone marrow and lymph node biopsies were ordered. Surgical pathology of the lymph node confirmed the diagnosis of Kaposi sarcoma and multicentric Castleman disease. This case highlights a rare manifestation of HIV and HHV-8 that is even more rare given the young age of the patient. The patient also lacked the classical skin changes associated with Kaposi Sarcoma. This case emphasizes the importance of a thorough workup upon the initial diagnosis of HIV to ensure proper identification and treatment of more uncommon associated malignancies/ diseases.