Department of Internal Medicine, Cleveland Clinic, Akron General, Akron, OH, USA.
Department of Pathology, Cleveland Clinic, Akron General, Akron, OH, USA.
Am J Case Rep. 2023 Mar 7;24:e938801. doi: 10.12659/AJCR.938801.
BACKGROUND As an AIDS-defining illness, the neoplasm Kaposi sarcoma (KS) classically presents as cutaneous lesions that are often associated with periorbital edema. This association with KS is important because it frequently leads to the misuse of steroids in HIV-infected patients. This report presents 2 cases of AIDS-related Kaposi sarcoma (AIDS-KS) associated with severe steroid-unresponsive periorbital lymphedema that responded to chemotherapy. CASE REPORT Case 1: A 30-year-old African-American man with KS-related periorbital edema suffered progression after receiving multiple corticosteroids for a presumed hypersensitivity reaction. After multiple hospitalizations, the patient's KS had disseminated, and he eventually opted for hospice. Case 2: A 29-year-old White male with recurrent facial edema had been repeatedly treated with corticosteroids for impending anaphylaxis reactions. He had multiple admissions with similar presentations, and it was found that his KS had progressed. After receiving chemotherapy, his facial edema has not recurred. CONCLUSIONS The failure to recognize periorbital edema as tumor-associated edema has direct consequences for the management of AIDS-KS. In addition to a delay in administering chemotherapy, the mischaracterization of periorbital edema as a hypersensitivity/allergic reaction often prompts the use of corticosteroids, potentially exacerbating the underlying AIDS-KS. Despite the current evidence, clinicians continue to order steroids in advanced AIDS-KS patients presenting with periorbital edema. Although that management is started with the best intentions and done with concerns for airway compromise, this anchoring bias could lead to devastating consequences and a rather poor prognosis.
作为一种艾滋病定义性疾病，卡波西肉瘤（KS）这种肿瘤通常表现为皮肤损伤，常伴有眶周水肿。这种与 KS 的关联很重要，因为它常常导致 HIV 感染者中皮质类固醇的误用。本报告介绍了 2 例与 AIDS-KS 相关的、对类固醇治疗反应不佳的严重眶周淋巴水肿病例，这 2 例患者对化疗有反应。
病例 1：一名 30 岁的非裔美国男性，因 KS 相关眶周水肿，在接受多种皮质类固醇治疗疑似过敏反应后病情进展。在多次住院后，该患者的 KS 已扩散，最终选择了临终关怀。
病例 2：一名 29 岁的白人男性，因反复发作的面部水肿，多次因即将发生的过敏反应接受皮质类固醇治疗。他因类似的表现多次入院，发现他的 KS 已进展。接受化疗后，他的面部水肿未再复发。
未能将眶周水肿识别为肿瘤相关的水肿，会对 AIDS-KS 的治疗管理产生直接影响。除了延迟给予化疗外，将眶周水肿误诊为过敏/过敏反应，通常会促使使用皮质类固醇，这可能使潜在的 AIDS-KS 恶化。尽管有目前的证据，临床医生仍会在出现眶周水肿的晚期 AIDS-KS 患者中开具类固醇处方。尽管这种治疗管理的初衷是好的，而且是出于对气道阻塞的担忧，但这种锚定偏差可能导致灾难性的后果和较差的预后。
