organ transplant patients who have maintenance immunosuppression
Aetiology
in 1994, it was discovered that human herpesvirus-8 (HHV-8) aka Kaposi's sarcoma-associated herpesvirus (KSHV) was present in all these tumours
this virus is spread via saliva and is probably also sexually spread via oral sex or using saliva as a lubricant
it may also be spread via:
organ transplants
blood transfusion
Classification
Classic Kaposi sarcoma
tends to be a chronic indolent condition in elderly men in countries bordering the Mediterranean Sea where rates of KSHV/HHV-8 infection tend to be high
reddish, violaceous, or bluish-black macules and patches that usually start on the toes and soles and may spread to form plaques or nodules
treatment is generally surgical excision
Endemic Kaposi sarcoma
a more aggressive disease that infiltrates the skin extensively and mainly occurs in younger Africans from sub-Saharan Africa
African lymphadenopathic Kaposi sarcoma is aggressive, occurring in children under 10 years of age
African cutaneous Kaposi sarcoma presents with nodular, infiltrative, vascular masses on the extremities, mostly in men between the ages of 20 and 50
Immunosuppression-associated Kaposi sarcoma
occurs in organ transplant recipients who are immunosuppressed, especially by calcineurin inhibitors
recipient may have had pre-existing HHV-8 infection or may have acquired it from an infected transplanted organ
AIDS-associated Kaposi sarcoma
typical lesions tend to mainly affect head, back, neck, trunk, and mucous membranes, and can spread to GIT, lymph nodes and lungs
This form of KS is over 300 times more common in AIDS patients than in renal transplant recipients.
Treatment
currently incurable
Rx is aimed at treating the underlying immunosuppression which can slow or stop disease progression.
if there are few lesions, local measures such as radiation therapy or cryosurgery may be used.