Iatrogenic Kaposi’s sarcoma following therapy for rheumatoid arthritis

Kaposi’s sarcoma is an angioproliferative disorder, with four subtypes: iatrogenic, acquired immune deficiency syndrome (AIDS) related, African, and classic. The disease has a viral etiology and a multifactorial pathogenesis hinged on an immune dysfunction. Changes are multifocal, with a course ranging from indolent, with only skin manifestations, to fulminant, with extensive visceral involvement [1, 2]. An increased incidence of Kaposi’s sarcoma has been described in organ transplant recipients receiving immunosuppressive therapy. In addition, Kaposi’s sarcoma has been reported in patients treated with corticosteroid therapy. In the current view, all forms of Kaposi’s sarcoma have a common etiology in human herpesvirus (HHV)-8 infection, and the differences among them are due to the involvement of various cofactors. In fact, HHV-8 infection can be considered a necessary but not sufficient condition for the development of the disease, because further factors (genetic, immunologic, and environmental) are required. The role of cofactors can be attributed to their ability to interact with HHV-8, to affect the immune system, or to act as vasoactive agents. In this contribution, a survey of the current state of knowledge on many and various factors involved in Kaposi's sarcoma pathogenesis is carried out, in particular by highlighting the facts and controversies about the role of some drugs (quinine analogs and angiotensin-converting enzyme inhibitors) in the onset of the disease [3–6]. It is possible that the same agents may act as either stimulating or inhibiting cofactors according to the patient’s genetic background and variable interactions. Treatment guidelines for each form of Kaposi’s sarcoma are outlined, because a unique standard therapy for all of them cannot be considered due to heterogeneity of the disease. Management, which may depend on a variety of factors including the clinicopathologic type of Kaposi’s sarcoma and results of staging, ranges from no treatment to local measures such as intralesional vinblastine or systemic administration of cytotoxic chemotherapy for disseminated disease [1, 7–10].
We present an interesting case of iatrogenic Kaposi’s sarcoma, in which we considered three cofactors: immunosuppression, corticosteroids and anti-TNF- antibody.
The 57-year-old Caucasian woman was admitted to the Dermatology Department in 2014 because of extensive, multiple purple and brown plaques and nodules on all four extremities...


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