Infection or Malignancy, or Both? Kaposi Sarcoma Complicated by MRSA Infection: A Case Report

Abstract

Background: Kaposi sarcoma is an angioproliferative malignancy that presents as violaceous, pink, or red macules, plaques, or nodules. It is caused by human herpesvirus-8 infection of endothelial cells and primarily occurs in immunocompromised individuals, mainly those with human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS). These lesions may sometimes mimic or be misdiagnosed as cellulitis. Human herpesvirus -8 can also infect B cells, leading to cytokine-mediated syndromes such as multicentric Castleman disease, inflammatory cytokine syndromes, and lymphoproliferative disorders including primary effusion lymphoma and large B-cell lymphoma.

Case Presentation: A 46-year-old male with hypertension and prior methicillin-resistant Staphylococcus aureus (MRSA) cellulitis presented with facial swelling and presumed cellulitis. Further assessment revealed multiple violaceous papules across the body. HIV/AIDS was diagnosed with a markedly guidance, with subsequent clinical and radiographic improvement. reduced CD4 count during workup for disseminated rash and recurrent infections. CT maxillofacial imaging demonstrated a soft tissue mass of the left palate with bony erosion and inflammatory changes. Chest CT angiography showed innumerable bilateral mass-like opacities concerning for metastatic disease or septic emboli. Left facial wound, blood, and bronchoalveolar lavage cultures grew MRSA. Skin biopsy from the chest wall lesions and palatal mass confirmed Kaposi sarcoma. The patient was treated with intravenous daptomycin per infectious disease recommendations and paclitaxel per oncology guidance, with subsequent clinical and radiographic improvement.

Conclusion: We conclude that history-taking, physical examination, and multidisciplinary collaboration are critical for timely diagnosis and management. In this case, recurrent cellulitis and disseminated rash prompted evaluation for underlying immunosuppression, leading to HIV diagnosis and appropriate treatment with favorable outcomes.