J Korean Soc Transplant.  2012 Dec;26(4):299-304. 10.4285/jkstn.2012.26.4.299.

Successful Sirolimus Treatment of Kaposi's Sarcoma in Multiple Pulmonary Nodules after Kidney Transplantation

• Kim SY
• Lee HJ
• Chung YJ
• Sheen S
• Lee JH
• Oh CK

• KMID: 2202434
• DOI: http://doi.org/10.4285/jkstn.2012.26.4.299

Abstract

Kaposi's sarcoma is one of the most serious complications associated with immune suppression treatment after kidney transplantation. Because it usually manifestations as skin lesions or lymphadenopathies, its clinical suspicion and tissue diagnosis is relatively easy. However, Kaposi's sarcoma presented as multiple pulmonary nodules without skin manifestations is not easily detected early and usually has a deadly prognosis. We present the case of a 36-year-old male who underwent kidney transplantation 13 months ago and has been on tacrolimus and mycophenolate mofetil (MMF)-based immune suppression presented dry cough, blood tinged sputum, and multiple pulmonary nodules without any skin lesions. Both bronchoscopic washing cytology and fine needle aspiration cytology of peripheral lung tissues were performed but failed due to low cellular yields. A video-assisted thoracoscopic biopsy subsequently revealed Kaposi's sarcoma. Following the diagnosis, we changed the immune suppression from a tacrolimus and MMF-based regimen to a sirolimus-based regimen. Respiratory symptoms gradually disappeared and we found complete remission on follow-up radiologic evaluations. Thus sirolimus may be the preferred method of treatment for patients with immune suppression after kidney transplantation.

Keyword

Kaposi's sarcoma; Kidney transplantation; Multiple pulmonary nodules; Immunesuppression; Sirolimus

MeSH Terms

Biopsy
Biopsy, Fine-Needle
Cough
Follow-Up Studies
Humans
Kidney
Kidney Transplantation
Lung
Male
Multiple Pulmonary Nodules
Mycophenolic Acid
Prognosis
Sarcoma, Kaposi
Sirolimus
Skin
Skin Manifestations
Sputum
Tacrolimus
Tolnaftate
Mycophenolic Acid
Sirolimus
Tacrolimus
Tolnaftate

Figure

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  Fig. 1 (A) Initial simple chest radiography and (B) chest computed tomography showed multiple pulmonary nodules.

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  Fig. 2 Positron emission tomography-computed tomography (PET-CT) showed multiple 18F-fluorodeoxyglucose (18F-FDG) uptake nodules which confined in thorax. (A) axial CT image. (B) Axial PET image. (C) Axial co-registered image. (D) Coronal PET image.

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  Fig. 3 (A) Video-assisted thoracoscopic biopsy and (B) gross figure of specimen from lingular division, left upper lobe. Microscopic figures of Kaposi's sarcoma showed (C) abnormal spindle cells and hypervascularity (HE stain, ×250) and (D) intracellular hyaline globules (HE stain, ×400).

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  Fig. 4 Immune suppression and clinical course after kidney transplantation.

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  Fig. 5 (A) Sixth month follow-up simple chest radiography and (B) chest computed tomography showed complete remission.

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