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KAPOSI SARCOMA IN A LUNG TRANSPLANT RECIPIENT: A CASE REPORT

      TOPIC: Transplantation
      TYPE: Fellow Case Reports
      INTRODUCTION: Kaposi's sarcoma is closely associated with solid organ transplant, but remains extremely rare after lung transplantation. The course of the malignancy in the setting of lung transplant is limited to the experience of few existing case reports (1). Herein, we describe the unique case of biopsy-proven cutaneous Kaposi's sarcoma in a lung transplant recipient.
      CASE PRESENTATION: We reviewed the post-transplant course of biopsy-proven Kaposi's sarcoma that developed in a 70-year-old male who underwent bilateral lung transplant for IPF in July 2019.
      DISCUSSION: This patient had an uneventful perioperative course; standard maintenance immunosuppression regimen consisted of tacrolimus, mycophenolate mofetil, and prednisone, with aim of tacrolimus trough levels at 10-12 ng/mL through the first post-transplant year. In the first year, the patient developed three episodes of minimal (A1B0) acute cellular rejection with need for corticotherapy. At the 1-year post-transplant follow-up visit, the patient reported concern with a few cutaneous lesions on the forearm and neck that grossly appeared as brown-discolored plaques (Figures A-D). Dermal punch biopsy revealed a lesion of cancerous etiology, composed of elongated spindle cells – namely, Kaposi's sarcoma. PET scan failed to show evidence of any other focus of infection. Meanwhile, quantitative analysis of human herpesvirus 8 using real-time PCR assay demonstrated elevated viral load (4.8 × 106 DNA copies/106 cells). Immunosuppression was reduced (mycophenolate mofetil was discontinued), and sirolimus was substituted for tacrolimus. At present, the patient's lung allograft function remains stable, and no other foci of Kaposi's sarcoma have been identified.
      CONCLUSIONS: Although Kaposi's sarcoma is a well-known entity and abundantly described in solid organ transplant, it is rarely encountered in lung transplant recipients. Thus, the long-term prognosis of Kaposi's sarcoma is poorly defined in these patients.
      REFERENCE #1: Turkkan S, Subasi M, Celik Basaran F, Sahin MF, Yazicioglu A, Demirag F, Yekeler E. Rapidly Progressive Pulmonary Kaposi Sarcoma After Bilateral Sequential Lung Transplant: A Case Report. Exp Clin Transplant. 2020 Mar 4. doi: 10.6002/ect.2019.0246. Epub ahead of print. PMID: 32133944.
      DISCLOSURES: No relevant relationships by Ashwini Arjuna, source=Web Response
      No relevant relationships by Hesham Mohamed, source=Web Response
      No relevant relationships by Michael Olson, source=Web Response
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