Limits...
Atypical Kaposi Sarcoma of the Tongue in HIV Positive Tanzanian Female.

Shao E, Ruhangisa F, Minja N, Nnko K, Katundu D, Semango G, Mbwilo E, Mwasamwaja A, Kilonzo K, Lyaruu I - Case Rep Infect Dis (2015)

Bottom Line: This patient was newly diagnosed and had no history of antiretroviral therapy (ART), radiotherapy, or immunosuppressive drugs prior to this admission.Clinically, there were no dermatological features of KS lesions which are purple, red, or brown and which may be flat, raised (plaques), or bumpy (nodules) except for fungating and protruding enlarged tongue which was necrotic.Histologically, it was proven to be the most common type of KS "epidemic" or AIDS-related KS.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Kilimanjaro Christian Medical Centre, P.O. Box 3010, Moshi, Tanzania ; Kilimanjaro Christian Medical University College, Tumaini University Makumira, P.O. Box 2240, Moshi, Tanzania ; Better Human Health Foundation, P.O. Box 1348, Moshi, Tanzania ; Image Doctors International, P.O. Box 16341, Arusha, Tanzania.

ABSTRACT
We report atypical case of Kaposi Sarcoma (KS) in a 32-year-old human immunodeficiency virus- (HIV-) infected female, involving only the tongue. Viral loads and CD4 T cells were measured and were 65,000 cps/mL and 10 cells/mL, respectively. This patient was newly diagnosed and had no history of antiretroviral therapy (ART), radiotherapy, or immunosuppressive drugs prior to this admission. Clinically, there were no dermatological features of KS lesions which are purple, red, or brown and which may be flat, raised (plaques), or bumpy (nodules) except for fungating and protruding enlarged tongue which was necrotic. Histologically, it was proven to be the most common type of KS "epidemic" or AIDS-related KS.

No MeSH data available.


Related in: MedlinePlus

Enlarged and fungating tongue completely occluding oral cavity as a result of infiltrating Kaposi Sarcoma in HIV positive Maasai female.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4664789&req=5

fig1: Enlarged and fungating tongue completely occluding oral cavity as a result of infiltrating Kaposi Sarcoma in HIV positive Maasai female.

Mentions: This was a thirty-two-year-old Maasai (one of pastoral tribes in Tanzania) female who was referred to our tertiary hospital in June 2015 with two weeks' history of recurrent fever, inability to swallow, weight loss, enlargement and protrusion of the tongue, and difficulty in speech. Her weight on time of admission was 43 kgs and height was 158 cm: Body Mass Index (BMI) was 17.22 Kg/m2. She was chronically ill with big necrotic and fungating protruding large tongue filling the whole oral cavity. The tongue has mixed lesions, that is, necrotic tissues and fresh wounds with easy bleeding plaques on the dorsal aspects of the tongue. She had also fungal infection (dermatophytes) of the upper lip (Figure 1). This tongue became large to the point that it occluded the oral cavity and made it difficult for her to speak or eat; it was accompanied by difficulty in breathing. Her tongue showed a cream coloured plaque at the lateral aspect with erythematous margin which was easily bleeding. Radiographic chest findings were remarkably normal; sputum microscopy for Acid Fast Bacilli was negative. Full blood picture was essentially normal except for the ESR which was 88 mm/hr, CD4 count 13 cells/μL, and CD4% of 2.2. Abdominal ultrasound was performed and revealed no mass or organomegaly. Liver functional test revealed hypoalbuminemia with normal range enzymes. Serology for hepatitis B surface antigen (HBsAg) and hepatitis C were all negative. Our working diagnoses were World Health Organization (WHO) Clinical stage 4 HIV disease, septicaemia, oropharyngeal candidiasis, upper airway obstruction, and lingual carcinoma with malnutrition. She commenced first-line ART (Tenofovir, Lamivudine, and Efavirenz) alongside antibiotics Ampicillin and Metronidazole, Flucanzole, and oxygen therapy. On the fourth day in the ward, the condition of the patient changed and became dyspnoeic with oxygen saturation of 40% on oxygen therapy. Intubation was tried but was unsuccessful due to enlarged tongue occluding the oropharynx; tracheostomy was performed but patient condition deteriorated and she passed away. Histology results came out after one week and showed extravasations of red blood cells, collagen splitting, and spindle cells tumours (Figure 2).


Atypical Kaposi Sarcoma of the Tongue in HIV Positive Tanzanian Female.

Shao E, Ruhangisa F, Minja N, Nnko K, Katundu D, Semango G, Mbwilo E, Mwasamwaja A, Kilonzo K, Lyaruu I - Case Rep Infect Dis (2015)

Enlarged and fungating tongue completely occluding oral cavity as a result of infiltrating Kaposi Sarcoma in HIV positive Maasai female.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664789&req=5

fig1: Enlarged and fungating tongue completely occluding oral cavity as a result of infiltrating Kaposi Sarcoma in HIV positive Maasai female.
Mentions: This was a thirty-two-year-old Maasai (one of pastoral tribes in Tanzania) female who was referred to our tertiary hospital in June 2015 with two weeks' history of recurrent fever, inability to swallow, weight loss, enlargement and protrusion of the tongue, and difficulty in speech. Her weight on time of admission was 43 kgs and height was 158 cm: Body Mass Index (BMI) was 17.22 Kg/m2. She was chronically ill with big necrotic and fungating protruding large tongue filling the whole oral cavity. The tongue has mixed lesions, that is, necrotic tissues and fresh wounds with easy bleeding plaques on the dorsal aspects of the tongue. She had also fungal infection (dermatophytes) of the upper lip (Figure 1). This tongue became large to the point that it occluded the oral cavity and made it difficult for her to speak or eat; it was accompanied by difficulty in breathing. Her tongue showed a cream coloured plaque at the lateral aspect with erythematous margin which was easily bleeding. Radiographic chest findings were remarkably normal; sputum microscopy for Acid Fast Bacilli was negative. Full blood picture was essentially normal except for the ESR which was 88 mm/hr, CD4 count 13 cells/μL, and CD4% of 2.2. Abdominal ultrasound was performed and revealed no mass or organomegaly. Liver functional test revealed hypoalbuminemia with normal range enzymes. Serology for hepatitis B surface antigen (HBsAg) and hepatitis C were all negative. Our working diagnoses were World Health Organization (WHO) Clinical stage 4 HIV disease, septicaemia, oropharyngeal candidiasis, upper airway obstruction, and lingual carcinoma with malnutrition. She commenced first-line ART (Tenofovir, Lamivudine, and Efavirenz) alongside antibiotics Ampicillin and Metronidazole, Flucanzole, and oxygen therapy. On the fourth day in the ward, the condition of the patient changed and became dyspnoeic with oxygen saturation of 40% on oxygen therapy. Intubation was tried but was unsuccessful due to enlarged tongue occluding the oropharynx; tracheostomy was performed but patient condition deteriorated and she passed away. Histology results came out after one week and showed extravasations of red blood cells, collagen splitting, and spindle cells tumours (Figure 2).

Bottom Line: This patient was newly diagnosed and had no history of antiretroviral therapy (ART), radiotherapy, or immunosuppressive drugs prior to this admission.Clinically, there were no dermatological features of KS lesions which are purple, red, or brown and which may be flat, raised (plaques), or bumpy (nodules) except for fungating and protruding enlarged tongue which was necrotic.Histologically, it was proven to be the most common type of KS "epidemic" or AIDS-related KS.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Kilimanjaro Christian Medical Centre, P.O. Box 3010, Moshi, Tanzania ; Kilimanjaro Christian Medical University College, Tumaini University Makumira, P.O. Box 2240, Moshi, Tanzania ; Better Human Health Foundation, P.O. Box 1348, Moshi, Tanzania ; Image Doctors International, P.O. Box 16341, Arusha, Tanzania.

ABSTRACT
We report atypical case of Kaposi Sarcoma (KS) in a 32-year-old human immunodeficiency virus- (HIV-) infected female, involving only the tongue. Viral loads and CD4 T cells were measured and were 65,000 cps/mL and 10 cells/mL, respectively. This patient was newly diagnosed and had no history of antiretroviral therapy (ART), radiotherapy, or immunosuppressive drugs prior to this admission. Clinically, there were no dermatological features of KS lesions which are purple, red, or brown and which may be flat, raised (plaques), or bumpy (nodules) except for fungating and protruding enlarged tongue which was necrotic. Histologically, it was proven to be the most common type of KS "epidemic" or AIDS-related KS.

No MeSH data available.


Related in: MedlinePlus