Rare Case of Disseminated Kaposi Sarcoma in a Kidney Transplant Recipient

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Introduction: Kaposi sarcoma (KS) is a rare, aggressive vascular tumor linked to human herpesvirus-8 (HHV-8), primarily seen in elderly Mediterranean and Eastern European men. It mainly affects immunocompromised individuals, such as those with HIV/AIDS or kidney transplant recipients. KS usually involves skin and subcutaneous tissue but may spread to internal organs, increasing morbidity and mortality. This case describes a kidney transplant recipient who developed cutaneous and visceral KS 2 years post-transplant. Case Description: A 41-year-old AA man with ESKD due to hypertension, a history of hemorrhagic stroke with hemiparesis, and deceased-donor kidney transplant 3 years prior, was admitted with bilateral leg edema, acute allograft dysfunction (creatinine 9 mg/dl), and high tacrolimus level (35 ng/ml).Tacrolimus was held, and angioplasty was performed for iliac vein occlusion, improving kidney function. He was discharged on tacrolimus, MMF, and prednisone. One month later, he returned with left arm edema and nodular, hyperpigmented skin lesions. CT venogram showed right internal jugular vein narrowing and pulmonary nodules. Fistulogram-guided angioplasty treated venous stenosis. Bronchoscopy showed no malignancy. Three months later, he was readmitted with weakness, weight loss, worsening skin lesions, early satiety, and anorexia. Imaging revealed more pulmonary nodules, mediastinal lymphadenopathy, pleural effusions, and thickened gastric/bladder walls. Biopsies (skin, GI tract, lymph nodes) showed atypical spindle cells positive for CD34, confirming KS Discussion: Visceral KS is aggressive and hard to detect early. In transplant patients, immunosuppression promotes HHV-8 activation and endothelial infection, enabling KS spread.Diagnosis often requires tissue biopsy.Management includes reducing immunosuppression while avoiding graft rejection. Options include mTOR inhibitors or chemotherapy (liposomal anthracyclines or taxanes).

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