Male, 36 years old, single, from low socioeconomic background, who began suffering from this disease in August 2005 with a progressive increase in volume of cervical, submaxillary, supraclavicular and inguinal lymph node chains.
Later, in January 2006 she presented diarrhea accompanied by nausea, vomiting, abdominal plenishment sensation, fever and loss of 5 kg of weight, reason why she came to the General Hospital of Mexico where a cervical lymph node biopsy was performed ECK.
An ELISA test for HIV was also performed, which was positive.
Subsequently, the patient was referred to the National Cancer Institute for evaluation and management.
Upon admission he was oriented, with tachycardia, fever, and Karnofsky index of 80%.
Physical examination revealed multiple adenopathies measuring 1.5 to 3 cm in diameter in several ganglionic chains, without mediastinal, liver or spleen involvement, and no cutaneous KS lesions were reported.
In the review of the new sections of the paraffin block of the lymph node, loss of normal architecture was observed as well as loss of well-defined borders, consisting of spindle cells arranged in grayish vascular pigments.
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The rest of the lymph node showed expansion of the interfollicular and medullary space by mature plasma cells.
Immunohistochemical study was performed which was positive in plasma cells for CD 13 8, kappa and lambda, which confirmed the diagnosis of ECDCP and KS.
The relevant laboratory data were: leukocytes: 11,900/mm3, absolute neutrophils: 8,500/mm3, platelets:000/mm3, Hb: 6.7 g/dl, hematocrit: 19.5%, albumin: 0.8 g1.
The viral load was 57,800 copies RNA/ml, CD4: 29 cells/mm3 and CD8: 490 cells/mm3, which confirmed a state of infection C3.
During its evolution nausea and vomiting were exacerbated, causing vomiting, fluid and electrolyte imbalance and acute renal failure.
Endoscopy and stomach biopsy were performed with the diagnostic suspicion of KS.
In the histopathological study, some fragments showed vascular neoplasia with microscopic characteristics similar to those described in the lymph node biopsy, consistent with KS.
The remaining fragments were infiltrated by malignant neoplasia with diffuse growth pattern in star sky.
The cells were large, had ovoid nuclei, prominent nucleolus and abundant cytoplasm, which gave them a plasmablastic aspect.
Immunohistochemistry was performed, showing positive cells for CD138 and light chain lambda and negative for CD20 and latent membrane protein (LMP-1).
Based on the morphological aspect and the immunohistochemical result, the diagnosis of gastric mucosa caused by LP coinfection with SK was concluded.
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Treatment was initiated with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP); however, the patient developed multiple organ failure and was admitted to the intensive care unit.
Upon request of his family member, the patient was discharged by voluntary discharge, despite health conditions and severe short-term prognosis.
