Aggressive Conjunctival Kaposi Sarcoma as the Initial Manifestation of Acquired Immunodeficiency Syndrome

Monday, April 20, 2015: 3:16 PM
Room 3 (San Diego Convention Center)
Sirikishan R. Shetty, MD
Hershel Rajendrakumar Patel, MS, MD
Lauren Bierman
Jay Lustbader, MD
Aruoriwo M. Oboh-Weilke, MD

Case report of a 23-year-old male who presented with an aggressive hemorrhagic lesion involving his left conjunctiva and cornea. A diagnosis of his underlying etiology was not made until his evaluation by the Ophthalmology service. Diagnosis of Kaposi sarcoma of the conjunctiva led to the evaluation for HIV/AIDS.

Chart review of a patient who presented to the eye clinic a month after he noticed redness of his left eye. He had been treated with topical eye drops without improvement. The patient admitted to symptoms involving other organ systems and a recent 20 lb unintentional weight loss.

The patient presented with a left hemorrhagic nodular bulbar conjunctival mass, a right hemorrhagic conjunctival lesion and violaceous facial skin lesions. He had been treated for a neck mass, pneumonia and facial lesions in the preceding month. The patient had seen various medical providers, but it was the suspicion of conjunctival Kaposi Sarcoma that led to his diagnosis.  After consenting to HIV/AIDS testing, biopsies of the ocular mass and axillary lymph nodes were performed.  The diagnoses of Kaposi Sarcoma were confirmed in both sites and serology was positive for HIV/AIDS. The patient was started on HAART and Doxorubicin.  The left conjunctival mass initially progressed, covering most of his cornea but eventually regressed by 6 months.

Ophthalmic involvement of Kaposi sarcoma as the initial manifestation of HIV/AIDS is rare with only a few reported cases.  With the availability of Highly active antiretroviral therapy (HAART), conjunctival Kaposi sarcoma has decreased in occurrence and is not commonly encountered by healthcare providers.  It is vital for all healthcare providers to have Kaposi Sarcoma in the differential diagnosis of a hemorrhagic conjunctival mass and be familiar with its association with HIV/AIDS.