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Correspondence
HHV8 genotype study in an HIV+ patient with concurrent Kaposi sarcoma and extracavitary primary effusion lymphoma
  1. King Him Fung1,
  2. Radha Raghupathy2,
  3. PC Denise Chan3,
  4. Grace Lui4,
  5. Choi Yin Lam3,
  6. Manton Cheung3,
  7. Anthony WH Chan5,
  8. Nelson Lee4,
  9. Shui Shan Lee3
  1. 1 Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
  2. 2 Partner State Key Laboratory of Oncology in South China, Sir Y K Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
  3. 3 Stanley Ho Center for Emerging Infectious Diseases, Department of Microbiology, The Chinese University of Hong Kong, Hong Kong, China
  4. 4 Division of Infectious Diseases, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
  5. 5 Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
  1. Correspondence to Shui Shan Lee, Department of Microbiology, Stanley Ho Center for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China; sslee{at}cuhk.edu.hk

https://doi.org/10.1136/jclinpath-2017-204485

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    Latent human herpes virus 8 (HHV8) infection has been implicated in malignancies occurring predominantly in HIV+ patients, including Kaposi sarcoma (KS), primary effusion lymphoma  (PEL), plasmablastic lymphoma and multicentric Castleman disease (MCD).1 However, the oncogenic mechanisms remain enigmatic. Whether different serotypes of HHV8 have the same oncogenic potential, and in patients with concurrent HHV8-related malignancies whether intrapatient genotype variability exists remains to be studied. Such knowledge will be important in understanding the pathogenesis of HHV8-associated neoplasms. We report a case of an HIV+ male with disseminated KS and PEL who subsequently developed recurrent extracavitary relapse of PEL. HHV8 subtyping revealed that both the KS and extracavitary PEL were caused by HHV8 serotype C.

    A Chinese man aged 26 years who had sex with men presented with a non-healing left foot lesion, suspected to be a callus. The lesion did not respond to local therapies and progressed to multiple violaceous papules over both his shins. Skin biopsy confirmed HHV8-positive KS. Blood work revealed HIV positivity with a CD4 of 57/μL and viral load of 1.4 × 105 copies/mL. He was started on combination antiretroviral therapy comprising Kaletra, Saquinavir and Truvada. Three months later, an increase in CD4 to 318/μL and drop in viral load to 270 copies/mL heralded progression of KS, consistent with immune reconstitution inflammatory syndrome. While awaiting chemotherapy, the patient was admitted with progressive shortness of breath, increasing bilateral leg oedema, fatigue and night sweats. His performance status declined and he remained bedbound. On examination, extensive mucosal and skin lesions of KS were noted. Bilateral enlarged inguinal lymph nodes were palpable. Bilateral breath sounds were diminished in the middle and lower zones of the lungs. Whole body CT showed multiple enlarged lymph nodes in the neck, mediastinum, axillae and inguinal regions with a conglomerate nodal soft tissue mass along the …

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    Footnotes

    • Contributors KHF prepared the clinical write up and discussion. RR envisioned the study, coordinated the work and edited the manuscript. DPC, CY Lam and MC performed the laboratory work. CY Lui and NL were responsible for clinical care for the patient and manuscript writing. AWHC reviewed the histopathology and helped with manuscript writing. SSL envisioned the study, oversaw the laboratory work and manuscript writing.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.