J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

Journal website https://www.journalmc.org

Case Report

Volume 15, Number 11, November 2024, pages 311-318

Pulmonary Kaposi Sarcoma in the Era of Antiretroviral Therapy: A Case Series

Figure 1. Frontal view chest X-ray showing large right-sided pleural effusion with adjacent atelectasis (green arrow).

Figure 2. Computed tomography angiography of the chest showing a large right-sided pleural effusion (red arrows) and multifocal lung infiltrates (yellow arrow).

Figure 3. Bronchoscopy images showing scattered erythematous endobronchial lesions and candidiasis in the hypopharynx (arrows).

Figure 4. Two views of a high-resolution computed tomography (CT) scan of the chest showing diffuse nodular opacities, with bilateral and roughly symmetrical perilymphatic and peribronchovascular distribution, marked peribronchial thickening, perivascular nodularity, multiple nodules along interlobar fissures, and thickening of interlobular septa (black arrows). Prominent mediastinal lymph nodes and an enlarged necrotic right upper paratracheal lymph node measuring 1.7 cm were also noted. A moderate right-sided pleural effusion could also be seen on the CT scan (green arrow).

Figure 5. Bronchoscopy images showing flat erythematous lesions in the left upper lobe and right lower lobe (arrows).

**Table 1.** Pertinent Laboratory Results for Cases 1 and 2
Laboratory test	Case 1	Case 2	Reference value
ALT: alanine transaminase; AST: aspartate aminotransferase; eGFR: estimated glomerular filtration rate; FTA: fluorescent treponemal antibody; HIV-1: human immunodeficiency virus 1; qPCR: quantitative polymerase chain reaction; RPR: rapid plasma reagin; STD: sexually transmitted disease.
Sodium	122	128	135 - 145 mEq/L
Serum albumin	3.2	4.0	3.5 - 5.7 g/dL
Total protein	7.4	10.3	6.4 - 8.4 g/dL
Blood urea nitrogen	9	15	7 - 23 mg/dL
Creatinine	0.42	0.93	0.60 - 1.30 mg/dL
eGFR	146	104	≥ 60 mL/min/1.73 m²
Alkaline phosphatase	108	157	34 - 104 U/L
AST	25	92	13 - 39 U/L
ALT	13	78	7 - 52 U/L
Troponin level	< 2	3	3 - 17 pg/mL
B-type natriuretic peptide level	29	9	1 - 100 pg/mL
White blood cell count	2.6	7.6	4.5 - 11.0 × 10³/mm³
Hemoglobin level	8.9	10.1	12.0 - 16.0 g/dL
Platelet count	272	170	140 - 440 × 10³/mm³
D-dimer	7.18		≤ 0.50
HIV-1 RNA viral load	134,000	2,860,000
Absolute CD4 helper count	93	163	359 - 1,519 cells/mm³
Pneumocystis carinii pneumonia qPCR	Negative	Negative
Lactate dehydrogenase level	135	233	140 - 271 U/L
Ferritin level	596.0	57	16.4 - 294 ng/mL
C-reactive protein		6.8	≤ 9.9 mg/dL
Erythrocyte sedimentation rate		83	0 - 10 mm/h
Lactic acid		1.0	0.5 - 2.2 mmol/L
FTA for Treponema pallidum	Reactive	Negative
Treponema pallidum antibodies	Reactive	Negative
RPR titer	1:1
STD panel
C3 and C4 complement	Normal

Table 1. Pertinent Laboratory Results for Cases 1 and 2

Laboratory test

Case 1

Case 2

Reference value

ALT: alanine transaminase; AST: aspartate aminotransferase; eGFR: estimated glomerular filtration rate; FTA: fluorescent treponemal antibody; HIV-1: human immunodeficiency virus 1; qPCR: quantitative polymerase chain reaction; RPR: rapid plasma reagin; STD: sexually transmitted disease.

Sodium

122

128

135 - 145 mEq/L

Serum albumin

3.2

4.0

3.5 - 5.7 g/dL

Total protein

7.4

10.3

6.4 - 8.4 g/dL

Blood urea nitrogen

7 - 23 mg/dL

Creatinine

0.42

0.93

0.60 - 1.30 mg/dL

eGFR

146

104

≥ 60 mL/min/1.73 m²

Alkaline phosphatase

108

157

34 - 104 U/L

AST

13 - 39 U/L

ALT

7 - 52 U/L

Troponin level

< 2

3 - 17 pg/mL

B-type natriuretic peptide level

1 - 100 pg/mL

White blood cell count

2.6

7.6

4.5 - 11.0 × 10³/mm³

Hemoglobin level

8.9

10.1

12.0 - 16.0 g/dL

Platelet count

272

170

140 - 440 × 10³/mm³

D-dimer

7.18

≤ 0.50

HIV-1 RNA viral load

134,000

2,860,000

Absolute CD4 helper count

163

359 - 1,519 cells/mm³

Pneumocystis carinii pneumonia qPCR

Negative

Lactate dehydrogenase level

135

233

140 - 271 U/L

Ferritin level

596.0

16.4 - 294 ng/mL

C-reactive protein

6.8

≤ 9.9 mg/dL

Erythrocyte sedimentation rate

0 - 10 mm/h

Lactic acid

1.0

0.5 - 2.2 mmol/L

FTA for Treponema pallidum

Reactive

Negative

Treponema pallidum antibodies

Reactive

Negative

RPR titer

1:1

STD panel

C3 and C4 complement

Normal

**Table 2.** Results for Pleural Fluid Analysis for Cases 1 and 2
Parameter	Case 1	Case 2
LDH: lactate dehydrogenase; RBC: red blood cell; WBC: white blood cell.
Specific gravity	1.346	1.360
Urea	9 mg/dL
Color	Orange	Bloody
Appearance	Cloudy	Cloudy
WBC	443/mm³	1,400/mm³
RBC	48,000/mm³	100,000/mm³
Neutrophil	4%	4%
Lymphocyte	63%	71%
Monocytes	21%	11%
Histocyte	10%	2%
Mesothelial cell	2%	12%
Albumin	2.7 g/dL	2.2 g/dL
Glucose	105 mg/dL	80 mg/dL
LDH	136 U/L	967 U/L
Protein	5.4 g/dL	6.8 g/dL
Cholesterol		53 mg/dL
Triglycerides		35 mg/dL

Table 2. Results for Pleural Fluid Analysis for Cases 1 and 2

Parameter

Case 1

Case 2

LDH: lactate dehydrogenase; RBC: red blood cell; WBC: white blood cell.

Specific gravity

1.346

1.360

Urea

9 mg/dL

Color

Orange

Bloody

Appearance

Cloudy

WBC

443/mm³

1,400/mm³

RBC

48,000/mm³

100,000/mm³

Neutrophil

Lymphocyte

63%

71%

Monocytes

21%

11%

Histocyte

10%

Mesothelial cell

12%

Albumin

2.7 g/dL

2.2 g/dL

Glucose

105 mg/dL

80 mg/dL

LDH

136 U/L

967 U/L

Protein

5.4 g/dL

6.8 g/dL

Cholesterol

53 mg/dL

Triglycerides

35 mg/dL