Scientific Letter
Kaposi Sarcoma and Lung Transplant: Two Case Reports
Sarcoma de Kaposi y trasplante pulmonar: dos casos clínicos
Serviço de Pneumologia, Centro Hospitalar São João, Oporto, Portugal
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Eleven months after transplant, on a routine visit, two small purpuric skin lesions in the patient's chest were identified. He was referred to the Dermatology outpatient department and clinical vigilance was decided. Five months later, due to progression of the skin lesions, (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a), he was submitted to cutaneous biopsy whose pathology revealed morphological features and HHV-8 positive cells, compatible with KS, and its digestive tract involvement was excluded. Meanwhile, he showed functional decline and the diagnosis of bronchiolitis obliterans was made, leading to changes in his immunosuppression from mycophenolate mofetil 1250<span class="elsevierStyleHsp" style=""></span>mg bid to everolimus 0.5<span class="elsevierStyleHsp" style=""></span>mg bid. Afterwards, he presented clinical worsening with dyspnoea, bilateral pulmonary infiltrates and respiratory failure without response to non-invasive ventilation, all portrayed as a possible pulmonary involvement by KS, associated with transplant rejection (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>b). The patient died two days after these symptoms began, without having started specific therapy for KS.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The second case describes a 35 years old male patient with bronchiectasis of unknown aetiology, submitted to BPT at the age of 30. Regarding post-transplant complications, the authors emphasise acute rejection with progression to bronchiolitis obliterans with functional stability without respiratory failure. He begun immunosuppression with everolimus 0.5<span class="elsevierStyleHsp" style=""></span>mg bid and tacrolimus 4.5<span class="elsevierStyleHsp" style=""></span>mg bid. Fifty months after transplant, he was hospitalized for both prostatitis and acute cholecystitis. During that period the patient presented severe anaemia (haemoglobin 6.8<span class="elsevierStyleHsp" style=""></span>g/dL) and he underwent endoscopic study which revealed multiple, vascular, round and elevated lesions dispersed in the stomach, suggestive of KS (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>c). The histological examination confirmed this suspicion after the identification of positive cells to HHV-8 and its serology was negative. Few days later, the patient died after the onset intra-abdominal sepsis.</p><p id="par0020" class="elsevierStylePara elsevierViewall">KS in lung transplant patients has been rarely described in literature, contrary to other solid organ recipients.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,4</span></a> Different clinical expressions and severity can occur, but usually they are aggressive, commonly involve skin and visceral organs<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a> and time from transplantation to diagnosis can vary widely (3–124 months).<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> KS related to immunosuppression usually disappears with mTOR inhibitors<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> or with modification, reduction or cessation of immunosuppressive drugs, which in lung transplant patients is not recommendable due to loss of the graft,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> making their therapeutic approach a challenge. Unfortunately, clinical deterioration in both patients did not allow us to start specific therapy for KS.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall">None to declare.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of Interests</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that there is no conflict of interests directly or indirectly related to the contents of the manuscript.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of Interests" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 537 "Ancho" => 2000 "Tamanyo" => 179947 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) KS skin lesions, (b) pulmonary involvement by KS and (c) KS lesions dispersed in the patient's stomach.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk of skin cancer and other malignancies in kidney, liver, heart and lung transplant recipients 1970 to 2008 – a Swedish population-based study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Krynitz" 1 => "G. Edgren" 2 => "B. Lindelof" 3 => "E. Baecklund" 4 => "C. Brattstrom" 5 => "H. Wilczek" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ijc.27765" "Revista" => array:6 [ "tituloSerie" => "Int J Cancer" "fecha" => "2013" "volumen" => "132" "paginaInicial" => "1429" "paginaFinal" => "1438" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22886725" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "130(4_MeetingAbstracts):332S-a-332S" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disseminated kaposi sarcoma in a lung transplant recipient with pulmonary, pleural, and cutaneous involvement" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T. Martinu" 1 => "D.W. Haden" 2 => "M.F. Reidy" 3 => "S.M. Palmer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Chest" "fecha" => "2006" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11115464" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Kaposi's sarcoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K. Antman" 1 => "Y. Chang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM200004063421407" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2000" "volumen" => "342" "paginaInicial" => "1027" "paginaFinal" => "1038" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10749966" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Symptomatic pulmonary allograft Kaposi's sarcoma in two lung transplant recipients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.J. Sathy" 1 => "T. Martinu" 2 => "K. Youens" 3 => "C.M. Lawrence" 4 => "D.N. Howell" 5 => "S.M. Palmer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Transpl" "fecha" => "2008, September" "volumen" => "8" "paginaInicial" => "1951" "paginaFinal" => "1956" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intestinal Kaposi sarcoma in a lung transplant recipient: therapy with mammalian target of rapamycin inhibitor and immunosuppression reduction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.B. Lund" 1 => "V. Paulsen" 2 => "P. Aukrust" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Heart Lung Transpl" "fecha" => "2013" "volumen" => "32" "paginaInicial" => "376" "paginaFinal" => "377" "itemHostRev" => array:3 [ "pii" => "S0002937813004742" "estado" => "S300" "issn" => "00029378" ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:3 [ "titulo" => "Acknowledgements" "texto" => "<p id="par0035" class="elsevierStylePara elsevierViewall">The authors are grateful to the staff of the pulmonology department and all physicians at Centro Hospitalar São João involved in these two cases.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000005300000011/v1_201710310034/S0300289617300911/v1_201710310034/en/main.assets" "Apartado" => array:4 [ "identificador" => "49741" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Scientific Letters / Cartas científicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005300000011/v1_201710310034/S0300289617300911/v1_201710310034/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289617300911?idApp=UINPBA00003Z" ]
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| 2022 September | 37 | 29 | 66 |
| 2022 August | 58 | 39 | 97 |
| 2022 July | 34 | 45 | 79 |
| 2022 June | 44 | 38 | 82 |
| 2022 May | 53 | 48 | 101 |
| 2022 April | 45 | 27 | 72 |
| 2022 March | 37 | 37 | 74 |
| 2022 February | 53 | 31 | 84 |
| 2022 January | 57 | 32 | 89 |
| 2021 December | 46 | 38 | 84 |
| 2021 November | 56 | 42 | 98 |
| 2021 October | 53 | 40 | 93 |
| 2021 September | 38 | 51 | 89 |
| 2021 August | 28 | 39 | 67 |
| 2021 July | 33 | 33 | 66 |
| 2021 June | 45 | 36 | 81 |
| 2021 May | 77 | 45 | 122 |
| 2021 April | 113 | 119 | 232 |
| 2021 March | 62 | 34 | 96 |
| 2021 February | 69 | 29 | 98 |
| 2021 January | 49 | 18 | 67 |
| 2020 December | 48 | 27 | 75 |
| 2020 November | 28 | 30 | 58 |
| 2020 October | 45 | 21 | 66 |
| 2020 September | 35 | 16 | 51 |
| 2020 August | 27 | 17 | 44 |
| 2020 July | 51 | 22 | 73 |
| 2020 June | 30 | 17 | 47 |
| 2020 May | 35 | 18 | 53 |
| 2020 April | 36 | 19 | 55 |
| 2020 March | 27 | 18 | 45 |
| 2020 February | 45 | 19 | 64 |
| 2020 January | 55 | 20 | 75 |
| 2019 December | 48 | 25 | 73 |
| 2019 November | 40 | 19 | 59 |
| 2019 October | 37 | 15 | 52 |
| 2019 September | 45 | 13 | 58 |
| 2019 August | 49 | 19 | 68 |
| 2019 July | 42 | 23 | 65 |
| 2019 June | 50 | 32 | 82 |
| 2019 May | 60 | 28 | 88 |
| 2019 April | 76 | 25 | 101 |
| 2019 March | 42 | 25 | 67 |
| 2019 February | 49 | 24 | 73 |
| 2019 January | 30 | 21 | 51 |
| 2018 December | 65 | 29 | 94 |
| 2018 November | 62 | 25 | 87 |
| 2018 October | 123 | 36 | 159 |
| 2018 September | 48 | 14 | 62 |
| 2018 July | 5 | 0 | 5 |
| 2018 May | 30 | 1 | 31 |
| 2018 April | 44 | 11 | 55 |
| 2018 March | 47 | 16 | 63 |
| 2018 February | 54 | 21 | 75 |
| 2018 January | 2 | 1 | 3 |
| 2017 December | 3 | 0 | 3 |
| 2017 November | 18 | 5 | 23 |
| 2017 June | 0 | 1 | 1 |
| 2017 May | 0 | 1 | 1 |
Show all
