case_images: PMC6702861_01
case_images: 28-year-old man with a history of human immunodeficiency virus/acquired immunodeficiency syndrome complicated by numerous prior opportunistic infections, presented with progressive dyspnea and chronic, nonproductive cough, diagnosed with pulmonary Kaposi sarcoma. Computerized tomography chest, lung window. Panels a-d demonstrating multiple, right greater than left-sided, ill-defined ground glass (white arrows) and solid (black arrows) peribronchovascular nodules.
case_images: JCIS-9-12-g001.jpg
case_images: PMC6702861_01_JCIS-9-12-g001.jpg
case_images: F1
case_images: Computerized tomography (CT) of the chest showed multiple bilateral, right greater than left-sided, ill-defined peribronchovascular ground-glass nodules [Figure 1].
case_images: 28-year-old man with a history of human immunodeficiency virus/acquired immunodeficiency syndrome complicated by numerous prior opportunistic infections, presented with progressive dyspnea and chronic, nonproductive cough, diagnosed with pulmonary Kaposi sarcoma. Scintigraphy demonstrating right greater than left lung delayed thallium uptake (panel a; black arrows) without corresponding gallium uptake (panel b).
case_images: JCIS-9-12-g002.jpg
case_images: PMC6702861_01_JCIS-9-12-g002.jpg
case_images: F2
case_images: Sequential thallium 201 and gallium 67 scintigraphy was notable for abnormal delayed thallium uptake in and the absence of gallium uptake, raising concern for pulmonary KS over lymphoproliferative disorders or opportunistic infections [Figure 2].
case_images: 28-year-old man with a history of human immunodeficiency virus/acquired immunodeficiency syndrome complicated by numerous prior opportunistic infections, presented with progressive dyspnea and chronic, nonproductive cough, diagnosed with pulmonary Kaposi sarcoma. Submandibular lymph node biopsy showing central sarcomatoid proliferation (hematoxylin and eosin, original magnification x100).
case_images: JCIS-9-12-g003.jpg
case_images: PMC6702861_01_JCIS-9-12-g003.jpg
case_images: F3
case_images: Based on these findings, the patient underwent an ultrasound-guided core biopsy of a sub-centimeter submandibular lymph node which revealed central sarcomatoid proliferation with positive immunohistochemical staining for CD31, CD34, and HHV-8, confirming the diagnosis of KS [Figure 3].
case_images: 28-year-old man with a history of human immunodeficiency virus/acquired immunodeficiency syndrome complicated by numerous prior opportunistic infections, presented with progressive dyspnea and chronic, nonproductive cough, diagnosed with pulmonary Kaposi sarcoma. Computerized tomography chest, lung window. Panels a and b demonstrating progressive bilateral ill-defined ground glass and solid peribronchovascular nodules, and interlobular septal thickening (black arrows). Computerized tomography chest with IV contrast, soft-tissue window. Panels c and d demonstrating mediastinal and hilar lymphadenopathy (white arrows).
case_images: JCIS-9-12-g004.jpg
case_images: PMC6702861_01_JCIS-9-12-g004.jpg
case_images: F4
case_images: Repeat thoracic imaging was notable for significant progression of the ill-defined peribronchovascular infiltrates, interlobular septal thickening, and mediastinal and hilar lymphadenopathy [Figure 4].
case_images: 28-year-old man with a history of human immunodeficiency virus/acquired immunodeficiency syndrome complicated by numerous prior opportunistic infections, presented with progressive dyspnea and chronic, nonproductive cough, diagnosed with pulmonary Kaposi sarcoma. Bronchoscopy images. Panel a and b showing characteristic red to slightly violaceous macular lesions in the mid and distal trachea (black arrows).
case_images: JCIS-9-12-g005.jpg
case_images: PMC6702861_01_JCIS-9-12-g005.jpg
case_images: F5
case_images: Repeat bronchoscopy revealed characteristic red to slightly violaceous macular lesions in the endobronchial tree, not seen on examination 2 months prior [Figure 5].