Kaposi sarcoma presenting as severe haemoptysis.

Case report In spring 1995, a 36 year old HIV positive African man with CD4 count of 10 x 106/1 presented at Singleton Hospital with severe life threatening haemoptysis. Careful examination of the skin and oral cavity showed no evidence of Kaposi sarcoma (KS). On admission his investigations revealed a platelet count of 30 x 109/1 and a drop of 5 g/dl of haemoglobin to 6.8 g/dl compared with a haemoglobin of 11 6 g/dl 3 weeks previously. Chest radiograph showed persistent shadowing in the right mid zone and computed tomography (CT) revealed bilateral perihilar pulmonary infiltrates with small bilateral pleural effusions. Extensive bleeding KS lesions throughout the bronchial tree were found on bronchoscopy (fig). He was transfused and commenced on tranexamic acid. His clotting times were slightly abnormal, which were corrected with fresh frozen plasma and intravenous vitamin K. Although he received only one dose of parenteral vincristine and bleomycin, the haemoptysis gradually settled over 3 weeks. The patient's condition' deteriorated and he developed hepatomegaly with obstructive jaundice. Blood culture was negative but culture for mycobacterium avium complex (MAC) was not performed. The ultrasound appearance