CASE 118 32-year-old man with AIDS, cough, and dyspnea Coned-down PA chest radiograph (Fig. 118.1A) demonstrates bilateral, symmetric, poorly defined nodular opacities measuring up to 3.0 cm in diameter with a predominantly perihilar distribution. The bronchovascular bundles appear thickened. Chest CT (lung window) (Figs. 118.1B, 118.1C) from another patient with a similar history reveals ill-defined and irregular or “flame-shaped” nodular opacities in a predominantly perihilar and peribronchovascular bundle distribution. Kaposi sarcoma • Lymphoma • Metastatic Disease Fig. 118.1 • Pneumocystis jiroveci Pneumonia • Mycobacterium tuberculosis Infection; Nontuberculous Mycobacterial Infection • Other Bacterial and Fungal Pulmonary Infections Kaposi sarcoma (KS) is a multicentric malignant neoplasm that originates from vascular and lymphatic endothelial cells. It occurs in 15–20% of HIV-infected male homosexuals, and in 1–3% of other HIV-infected individuals. The incidence of KS as an AIDS-defining illness has been decreasing over the last decade and is distinctly reduced in HIV-infected patients receiving antiretroviral therapy (ART). Cutaneous or visceral KS usually precedes lung involvement. There seems to be an association between infection with human herpesvirus 8 DNA and the development of KS. The HIV regulatory protein (transactivator target, TAT), important for viral replication, is also likely responsible for the proliferation of KS cells.
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