Baldini Francesco, Baiocchini Andrea, Schininà Vincenzo, Agrati Chiara, Giancola Maria Letizia, Alba Lucia, Grisetti Susanna, Del Nonno Franca, Capobianchi Maria Rosaria, Antinori Andrea
Clinical Department, National Institute for Infectious Diseases "L, Spallanzani" IRCCS, Via Portuense 292, 00149 Rome, Italy.
BMC Infect Dis. 2013 Dec 21;13:600. doi: 10.1186/1471-2334-13-600.
Central nervous system is a very rare site of Kaposi's sarcoma in acquired immunodeficiency syndrome. Kaposi's sarcoma, a neoplasm of endothelial origin, occurs mainly in the skin, but can involve many tissues, especially in patients with a poor immunity. Combination antiretroviral therapy, highly active against human immunodeficiency virus type-1, has caused a dramatic reduction of cutaneous and visceral involvements. No report of central nervous system localization of Kaposi's sarcoma is described since the introduction of combination antiretroviral therapy in the late 90's.
A 42 year-old Caucasian man affected by human immunodeficiency virus type-1 infection treated with combination antiretroviral therapy and showing relatively preserved immunity with low viral load presented gingival squamous cell carcinoma and visceral (lungs and lymph nodes) Kaposi's sarcoma. Chemotherapy and radiotherapy were performed with improvement of both neoplasms. Afterwards, a magnetic resonance imaging showed focal lesions of the brain. Despite new chemotherapy and radiotherapy the patient died. Histology after autopsy revealed brain lesions due to Kaposi's sarcoma with the detection of Human Herpesvirus 8 on tissue samples.
This is the first report in the combination antiretroviral therapy era of a very rare complication of Kaposi's sarcoma, such as that of brain localization, in a patient with a relatively good control of human immunodeficiency virus infection. Therefore, Kaposi's sarcoma should be considered in differential diagnosis with other intracranial mass lesions that can occur in human immunodeficiency virus infected-patients focusing the issue of appropriate treatment for central nervous system involvement.
在获得性免疫缺陷综合征中，中枢神经系统是卡波西肉瘤非常罕见的发病部位。卡波西肉瘤是一种起源于内皮细胞的肿瘤，主要发生于皮肤，但可累及许多组织，尤其是免疫力低下的患者。对人类免疫缺陷病毒1型具有高效活性的联合抗逆转录病毒疗法已使皮肤和内脏受累情况显著减少。自90年代末引入联合抗逆转录病毒疗法以来，尚无卡波西肉瘤中枢神经系统定位的报道。
一名42岁的白人男性，感染人类免疫缺陷病毒1型，接受联合抗逆转录病毒疗法治疗，病毒载量低，免疫力相对保留，出现牙龈鳞状细胞癌和内脏（肺和淋巴结）卡波西肉瘤。化疗和放疗后两种肿瘤均有所改善。之后，磁共振成像显示脑部有局灶性病变。尽管进行了新的化疗和放疗，患者仍死亡。尸检后的组织学检查显示脑部病变为卡波西肉瘤，组织样本检测到人类疱疹病毒8。
这是联合抗逆转录病毒疗法时代的首例报告，该报告涉及一名人类免疫缺陷病毒感染控制相对良好的患者发生的卡波西肉瘤非常罕见的并发症，如脑部定位。因此，在对人类免疫缺陷病毒感染患者可能出现的其他颅内肿块病变进行鉴别诊断时，应考虑卡波西肉瘤，重点关注中枢神经系统受累的适当治疗问题。
