Pulmonary Kaposi's Sarcoma in a Patient with HIV Infection: A Case Report

肺部卡波西氏肉瘤在一感染愛滋病毒患者之病例報告

王慈慧(Tzu-Hwei Wang) ； 許永祥(Yung-Hsiang Hsu) ； 許文林(Wen-Lin Hsu)

《放射治療與腫瘤學》 17卷2期 (2010/06) Pp. 153-159

https://doi.org/10.6316/TRO/201017(2)153

摘要

卡波西氏肉瘤是愛滋病患者最常罹患的腫瘤之一，然而此腫瘤的表現方式通常以皮膚上久不癒的潰瘍或多處突起的皮下腫瘤為主，只有在免疫力嚴重低下時才會轉移到內臟。通常先有皮膚上的症狀，之後才會發現內臟轉移，轉移到內臟的卡波西氏肉瘤其臨床症狀往往沒有特異性。以肺部卡波西氏肉瘤而言，其臨床表現常為咳嗽、咳血、或呼吸急促，但這些症狀在一般肺部感染亦會表現，不易區分與感染。這裡我們報導一例愛滋病病患在2002年診斷愛滋病後沒有規則服藥，2007年4月開始有咳嗽及左下肢色素沈澱症狀，一開始診斷間質性肺炎，以抗生素及抗愛滋病藥物治療後，肺部症狀改善但效下肢色素沈澱範圍持續擴大且形成潰瘍，病患接受截肢治療，病理切片最後確定診斷為卡波西氏肉瘤合併肺部轉移；並探討其致病機轉、診斷方法、及治療方式。

關鍵字

肺部卡波西氏肉瘤 ； 愛滋病 ； 轉移

並列摘要

Kaposi's sarcoma is the most common tumor in patients with human immunodeficiency virus (HIV) infection in the form of cutaneous lesion and seldom involved visceral organ except in severe immune deficiency situation. However, the clinical symptom with pulmonary Kaposi's sarcoma is not specific. Physician easily missed the diagnosis if other infection coexisted.
Here we describe a case who had been diagnosed with HIV infection. The patient developed pulmonary Kaposi's sarcoma proved pathologically 4 years later. A 42 years old man had diagnosis of HIV in 2002 and treated suboptimally with medication in another hospital. Unfortunately, productive cough with whitish sputum and hyperpigmentation macules over left lower leg occurred in April, 2007. Opportunistic pulmonary infection was first diagnosed due to severe immune deficiency situation even though there was no positive finding in the examination. CT guided biopsy had been performed resulting in interstitial pneumonitis initially.
The respiratory symptoms improved after prophylactic antibiotics treatment and anti-HIV medication. However, macules over his leg aggravated 2 months later and treated by amputation. Kaposi's sarcoma of left leg was diagnosed according to histologic pattern. After reviewing the previous lung biopsy, AIDS-associated KS of left leg with lung metastasis was finally diagnosed. We also review the liturature to discuss epidemiology, incidence, clinical symptoms, pathogenesis, diagnostic methods and treatments. Concomitant pulmonary infection may underlying pulmonary KS. In addition, the lesions in the lung may be subtle. Physician should be alert of the existence of pulmonary KS and opportunistic infection, especially in patients who had already known to have extrapulmonary KS.

並列關鍵字

Pulmonary Kaposi's sarcoma ； HIV ； Metastases