RESUMO
SUMMARY Kaposi’s sarcoma (KS) is a multicentric lymphoproliferative malignancy. Most of the time this tumor is confined to the skin and subcutaneous tissue, but it can present with widespread visceral involvement, such as in the lung. Pulmonary KS is the most frequent form in young adult males, in a ratio of 15:1. The disease usually affects individuals with low CD4 lymphocyte counts (<150-200 cells/mm3). We report a case of a female patient aged 35 years, with the presence of skin lesions, self-limiting episodes of diarrhea and weight loss of 15 kg for nearly 9 months, progressing to persistent fever. AIDS was diagnosed and biopsy of the lesions revealed Kaposi’s sarcoma. Computed tomography of the chest showed peribronchovascular thickening, areas of ground glass opacity, condensations with air bronchograms surrounded by ground glass opacity (halo sign) and bilateral pleural effusion. The diagnosis of pulmonary KS is still a challenge, especially due to the occurrence of other opportunistic diseases that may also occur concurrently. Therefore, suspecting this diagnosis based on clinical and laboratory manifestations, and even more with CT findings, is fundamental, especially in patients who already have the cutaneous form of the disease.
RESUMO O sarcoma de Kaposi (SK) é uma neoplasia angioproliferativa maligna multicêntrica. Na maioria das vezes, esse tumor restringe-se à pele e ao tecido subcutâneo, mas pode cursar com comprometimento visceral amplamente disseminado, como é o caso do pulmão. O SK pulmonar é a forma mais frequente em homens adultos jovens, em uma proporção de 15:1. A doença geralmente acomete indivíduos com baixa contagem de linfócitos CD4 (<150-200 células/mm3). Relatamos um caso de uma paciente do sexo feminino, 35 anos, com presença de lesões cutâneas, episódios de diarreia autolimitada e perda de peso de 15 kg havia aproximadamente 9 meses, evoluindo para quadro febril persistente. Foi dado o diagnóstico de aids e foi realizada biópsia das lesões evidenciando sarcoma de Kaposi. A tomografia computadorizada do tórax evidenciou imagens de espessamento peribroncovascular, áreas de vidro fosco, condensações com broncogramas aéreos circundados por área de vidro fosco (sinal do halo) e derrame pleural bilateral. O diagnóstico da forma pulmonar de SK ainda é um desafio, principalmente pela ocorrência de outras doenças oportunistas que, inclusive, podem ocorrer de forma concomitante. Portanto, a suspeição desse diagnóstico pelas manifestações clínicas, laboratoriais e, principalmente, tomográficas é de fundamental importância, sobretudo em pacientes que já apresentam a forma cutânea da doença.
Assuntos
Humanos , Feminino , Adulto , Sarcoma de Kaposi/diagnóstico , Neoplasias Pulmonares/diagnóstico , Sarcoma de Kaposi/patologia , Sarcoma de Kaposi/tratamento farmacológico , Biópsia , Tomografia Computadorizada por Raios X , Síndrome da Imunodeficiência Adquirida/patologia , Evolução Fatal , Pulmão/patologia , Pulmão/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/tratamento farmacológicoRESUMO
Kaposi's sarcoma (KS) is a multicentric lymphoproliferative malignancy. Most of the time this tumor is confined to the skin and subcutaneous tissue, but it can present with widespread visceral involvement, such as in the lung. Pulmonary KS is the most frequent form in young adult males, in a ratio of 15:1. The disease usually affects individuals with low CD4 lymphocyte counts (<150-200 cells/mm3). We report a case of a female patient aged 35 years, with the presence of skin lesions, self-limiting episodes of diarrhea and weight loss of 15 kg for nearly 9 months, progressing to persistent fever. AIDS was diagnosed and biopsy of the lesions revealed Kaposi's sarcoma. Computed tomography of the chest showed peribronchovascular thickening, areas of ground glass opacity, condensations with air bronchograms surrounded by ground glass opacity (halo sign) and bilateral pleural effusion. The diagnosis of pulmonary KS is still a challenge, especially due to the occurrence of other opportunistic diseases that may also occur concurrently. Therefore, suspecting this diagnosis based on clinical and laboratory manifestations, and even more with CT findings, is fundamental, especially in patients who already have the cutaneous form of the disease.