J Korean Soc Transplant.  2012 Dec;26(4):293-298. 10.4285/jkstn.2012.26.4.293.

Successful Sirolimus Treatment of Multiple Visceral Kaposi's Sarcoma in a Renal Allograft Patient

• Kim MH
• Kim MS
• Cha YJ
• Park KS
• Kim BS
• Lee S

• KMID: 2202433
• DOI: http://doi.org/10.4285/jkstn.2012.26.4.293

Abstract

The use of immunosuppressant's increases the risk of developing malignancies in renal allograft patients. One of the most important malignancies, Kaposi's sarcoma, can cause mortality and graft failure among renal allograft patients. We report the case of a 39-year-old male diagnosed with multiple visceral Kaposi's sarcoma 6 months after a second cadaveric renal allograft. The patient's renal function was markedly deteriorated at admission and required hemodialysis initially. Radiologic studies revealed Kaposi's sarcoma in multiple lymph nodes, liver, lung, and peritoneum. The excisional biopsy of an inguinal lymph node confirmed this diagnosis. After diagnosis, tacrolimus treatment was gradually decreased, and sirolimus treatment initiated. The patient did not receive any chemotherapy or radiotherapy. The Kaposi's sarcoma lesions decreased dramatically (both in size and number) 1 month after sirolimus treatment, and kidney graft function improved. This case thus shows successful sirolimus treatment of visceral Kaposi's sarcoma in a renal allograft patient.

Keyword

Kidney transplantation; Kaposi sarcoma; Sirolimus

MeSH Terms

Biopsy
Cadaver
Humans
Kidney
Kidney Transplantation
Liver
Lung
Lymph Nodes
Male
Peritoneum
Renal Dialysis
Sarcoma, Kaposi
Sirolimus
Tacrolimus
Transplantation, Homologous
Transplants
Sirolimus
Tacrolimus

Figure

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  Fig. 1 Serum creatinine flow of the patient after second renal allograft from deceased donor. Abbreviations: DGF, delayed graft function; ACR, acute cellular rejection; BKVN, BK polyomavirus nephropathy; KS, Kaposi's sarcoma; ATG, antithymoglobulin; TAC, tacrolimus; MMF, mycophenolate mofetil; SRL, sirolimus.

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  Fig. 2 Abdomino-pelvic computed tomography of the patient shows innumerable solid nodules in both lobes of liver, multiple lymphadenopathy involving periportal, celiac axis, and periaortic area.

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  Fig. 3 Monomorphic spindle cells arranged in ill-defined fasicles, which are separated by slit-like vessels containing erythrocytes (HE stain, ×200).

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  Fig. 4 Some areas show ectatic vascular spaces, lined by atypical endothelial cells (HE stain, ×200).

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  Fig. 5 Human herpesvirus 8 (HHV-8) immunohistochemical staining displays nuclear immunoreactivity in the endothelium and spindled component (HHV-8 stain, ×200).

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  Fig. 6 Remission of Kaposi's sarcoma on positron emission tomography-computed tomography. The right figure shows markedly decreased degree of fludeoxyglucose uptakes in bilateral neck lymph nodes (LNs), liver mass, intra-abdominal lymph nodes with residual uptakes in the right mediastinum, left neck and axilla lymph nodes.

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  Fig. 7 Clinical course of the patient. Abbreviations: HD, hemodialysis; SRL, sirolimus; PET-CT, positron emission tomography-computed tomography.

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  Fig. 8 Immunosuppressant serum level. Abbreviations: SRL, sirolimus; TAC, tacrolimus.

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