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Open Access 01-12-2021 | SARS-CoV-2 | Case report

Disseminated Kaposi sarcoma following COVID-19 in a 61-year-old Albanian immunocompetent man: a case report and review of the literature

Authors: Giulia Gardini, Silvia Odolini, Giovanni Moioli, Dorothea Angela Papalia, Vittorio Ferrari, Alberto Matteelli, Silvio Caligaris

Published in: European Journal of Medical Research | Issue 1/2021

Abstract

Background

COVID-19 and its related anti-inflammatory treatment (steroids, immunomodulators) may induce the reactivation of latent bacterial, parasitic, and viral infections. According to our knowledge, no case of disseminated HHV-8-related Kaposi sarcoma (KS) after COVID-19 and its treatment has been described so far. Only one case of cutaneous KS concurrently with COVID-19 has been previously reported.

Case presentation

We describe a case of disseminated KS in a 61-year-old immunocompetent Albanian man after hospitalization for COVID-19.

Methods for literature research

We used PubMed as biomedical database for the literature research. We selected keyword combinations including “Kaposi sarcoma,” “HHV-8,” “immunocompetent,” “COVID-19,” “SARS-CoV-2,” and “steroids.” No time or language limitation was set. Titles and abstracts of selected articles were systematically screened. Articles were included in the examination if they were published under free access through the digital library of the University of Brescia (Italy), and provided full text. Articles were excluded if the topic was beyond the aim of our study. Finally, we selected 15 articles.

Results

We describe a case of KS in COVID-19 patient and postulate that Interleukin-6 (IL-6) activity and steroid-induced immunodeficiency may play a major role in KS emergence. No published case of disseminated KS following COVID-19 in otherwise healthy individuals was found through the systematic literature review, despite the high incidence of COVID-19 in areas with medium–high prevalence of HHV-8 infection. This observation might be explained by the role of individual genetic susceptibility factors.

Conclusions

SARS-CoV-2 infection and its treatment may lead to reactivation of several latent infections, including HHV-8 and its related clinical syndrome, Kaposi sarcoma.

Marchese V, Crosato V, Gulletta M, Castelnuovo F, Cristini G, Matteelli A, Castelli F. Strongyloides infection manifested during immunosuppressive therapy for SARS-CoV-2 pneumonia. Infection. 2021;49(3):539–42. https://doi.org/10.1007/s15010-020-01522-4 (Epub 2020 Sep 10).CrossRefPubMed

Rodríguez-Tajes S, Miralpeix A, Costa J, López-Suñé E, Laguno M, Pocurull A, Lens S, Mariño Z, Forns X. Low risk of hepatitis B reactivation in patients with severe COVID-19 who receive immunosuppressive therapy. J Viral Hepat. 2021;28(1):89–94. https://doi.org/10.1111/jvh.13410 (Epub 2020 Oct 12).CrossRefPubMed

Xu R, et al. Co-reactivation of the human herpesvirus alpha subfamily (herpes simplex virus-1 and varicella zoster virus) in a critically ill patient with COVID-19. Br J Dermatol. 2020;183:1145–7.CrossRef

Tartari F, et al. Herpes zoster in COVID-19-positive patients. Int J Dermatol. 2020;59:1028–9.CrossRef

Drago F, Ciccarese G, Rebora A, Parodi A. Human herpesvirus 6, 7 and Epstein Barr virus reactivation in pityriasis rosea during COVID-19. J Med Virol. 2021;93:1850–1.CrossRef

Leoni E, Cerati M, Finzi G, Lombardo M, Sessa F. COVID-19 and HHV8 first spotted together: an affair under electron microscopy. J Eur Acad Dermatol Venereol. 2021;35(5):e311–2. https://doi.org/10.1111/jdv.17123 (Epub 2021 Feb 5).CrossRefPubMed

Krown ES, Chadha Singh J. Classic Kaposi sarcoma: clinical features, staging, diagnosis, and treatment. https://www.uptodate.com/contents/classic-kaposi-sarcoma-clinical-features-staging-diagnosis-andtreatment?search=sarcoma%20kaposi&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3. Accessed date 7 June 21.

Casper C. Disease associations of human herpesvirus 8 infection. https://www.uptodate.com/contents/disease-associations-of-human-herpesvirus-8infection?search=hhv8&source=search_result&selectedTitle=1~78&usage_type=default&display_rank=1. Accessed date 7 June 21.

Kim B, Jeon YK, Kim CW. Kaposi sarcoma herpes virus-associated hemophagocytic syndrome complicated by multicentric castleman disease and Kaposi sarcoma in a HIV-negative immunocompetent patient: an autopsy case. J Korean Med Sci. 2009;24(5):970–4. https://doi.org/10.3346/jkms.2009.24.5.970 (Epub 2009 Sep 24).CrossRefPubMedPubMedCentral

10.

Li CF, Ye H, Liu H, Du MQ, Chuang SS. Fatal HHV-8-associated hemophagocytic syndrome in an HIV-negative immunocompetent patient with plasmablastic variant of multicentric Castleman disease (plasmablastic microlymphoma). Am J Surg Pathol. 2006;30(1):123–7. https://doi.org/10.1097/01.pas.0000172293.59785.b4.CrossRefPubMed

11.

Re A, Facchetti F, Borlenghi E, Cattaneo C, Capucci MA, Ungari M, Barozzi P, Vallerini D, Potenza L, Torelli G, Rossi G, Luppi M. Fatal hemophagocytic syndrome related to active human herpesvirus-8/Kaposi sarcoma-associated herpesvirus infection in human immunodeficiency virus-negative, non-transplant patients without related malignancies. Eur J Haematol. 2007;78(4):361–4. https://doi.org/10.1111/j.1600-0609.2007.00828.x (Epub 2007 Jan 22).CrossRefPubMed

12.

Zoubeidi H, Aydi Z, Daoud F, Rachdi I, Koubaa W, Jouini R, Baili L, Debbiche A, Ben Dhaou B, Boussema F. Kaposi’s sarcoma presenting as lymphadenopathy in an immunocompetent patient. Eur J Case Rep Intern Med. 2016;3(7): 000493. https://doi.org/10.12890/2016_000493.CrossRefPubMedPubMedCentral

13.

Florek AG, Eilers D, Armstrong AW. A case of Kaposi sarcoma in an immunocompetent, heterosexual Irish man: a discussion of etiology and viral transmission. Dermatol Online J. 2015;21(10):13030/qt1d6409wz.CrossRef

14.

Sikora AG, Shnayder Y, Yee H, DeLacure MD. Oropharyngeal Kaposi sarcoma in related persons negative for human immunodeficiency virus. Ann Otol Rhinol Laryngol. 2008;117(3):172–6. https://doi.org/10.1177/000348940811700303.CrossRefPubMed

15.

Hinojosa T, Lewis DJ, Liu M, Garza G, Vangipuram R, Ramos E, Salas-Alanis JC, Nawas ZY, Tyring SK. Nonepidemic Kaposi sarcoma: a recently proposed category. JAAD Case Rep. 2017;3(5):441–3. https://doi.org/10.1016/j.jdcr.2017.04.012.CrossRefPubMedPubMedCentral

16.

Altunay I, Kucukunal A, Demirci GT, Ates B. Variable clinical presentations of classic Kaposi sarcoma in Turkish patients. J Dermatol Case Rep. 2012;6(1):8–13. https://doi.org/10.3315/jdcr.2012.1088.CrossRefPubMedPubMedCentral

17.

Coomes EA, Haghbayan H. Interleukin-6 in COVID-19: a systematic review and meta-analysis. Rev Med Virol. 2020;30(6):1–9. https://doi.org/10.1002/rmv.2141 (Epub 2020 Aug 26).CrossRef

18.

Chen J, Dai L, Barrett L, Post SR, Qin Z. SARS-CoV-2 proteins and anti-COVID-19 drugs induce lytic reactivation of an oncogenic virus. bioRxiv. 2020. https://doi.org/10.1101/2020.10.02.324228.CrossRefPubMedPubMedCentral

19.

Trattner A, Hodak E, David M, Sandbank M. The appearance of Kaposi sarcoma during corticosteroid therapy. Cancer. 1993;72(5):1779–83. https://doi.org/10.1002/10970142(19930901)72:5%3c1779::aid-cncr2820720543%3e3.0.co;2-m.CrossRefPubMed

20.

Windon AL, Shroff SG. Iatrogenic Kaposi’s sarcoma in an HIV-negative young male with Crohn’s disease and IgA nephropathy: a case report and brief review of the literature. Int J Surg Pathol. 2018;26(3):276–82. https://doi.org/10.1177/1066896917736610 (Epub 2017 Nov 23).CrossRefPubMed

21.

Brambilla L, Esposito L, Nazzaro G, Tourlaki A. Onset of Kaposi sarcoma and Merkel cell carcinoma during low-dose steroid therapy for rheumatic polymyalgia. Clin Exp Dermatol. 2017;42(6):702–4. https://doi.org/10.1111/ced.13151 (Epub 2017 Jun 9).CrossRefPubMed

22.

Htet KZ, Waul M, Edelstein H, Mui S, Cherny S, Leslie K. Primary nasal Kaposi sarcoma in well-controlled HIV-positive patient with normal CD4 count associated with long-term nasal steroid use. Int J STD AIDS. 2021;32(6):582–4. https://doi.org/10.1177/0956462420980644 (Epub 2021 Feb 3).CrossRefPubMed

23.

Simeoni S, Puccetti A, Moruzzi S, Tinazzi E, Peterlana D, Lunardi C. Dermatomyositis complicated with Kaposi sarcoma: a case report. Clin Rheumatol. 2007;26(3):440–2. https://doi.org/10.1007/s10067-005-0148-3 (Epub 2006 Jan 26).CrossRefPubMed

24.

Fierro MT, Savoia P, Quaglino P, Novero D, Bernengo MG. Disseminated Kaposi’s sarcoma associated with idiopathic CD4+ lymphocytopenia and low dose steroid therapy. Clin Exp Dermatol. 2005;30(4):395–7. https://doi.org/10.1111/j.1365-2230.2005.01795.x.CrossRefPubMed

25.

Graffeo R, Ranno S, Marchetti S, Capodicasa N, Schito AM, Fuga L, Amico R, Cattani P, Fadda G. HHV 8 seroprevalence and transmission within Albanian family groups. New Microbiol. 2003;26(1):1–6.PubMed

26.

Schinaia N, Kodra Y, Sarmati L, Andreoni M, Bino S, Qyra S, Rezza G. Prevalence of HHV-8 infection in Albanian adults and association with HBV and HCV. Eur J Epidemiol. 2004;19(5):467–9. https://doi.org/10.1023/b:ejep.0000027358.38997.66.CrossRefPubMed

Title: Disseminated Kaposi sarcoma following COVID-19 in a 61-year-old Albanian immunocompetent man: a case report and review of the literature
Authors: Giulia Gardini
Silvia Odolini
Giovanni Moioli
Dorothea Angela Papalia
Vittorio Ferrari
Alberto Matteelli
Silvio Caligaris
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: SARS-CoV-2
Kaposi Sarcoma
Kaposi Sarcoma
COVID-19
Published in: European Journal of Medical Research / Issue 1/2021
Electronic ISSN: 2047-783X
DOI: https://doi.org/10.1186/s40001-021-00620-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Disseminated Kaposi sarcoma following COVID-19 in a 61-year-old Albanian immunocompetent man: a case report and review of the literature

Abstract

Background

Case presentation

Methods for literature research

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Case presentation

Methods for literature research

Results

Conclusions

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