Kaposi Sarcoma in a Patient with Chronic Renal Failure Undergoing Dialysis
A 51-year-old Korean man visited a dermatology clinic because he developed hyperpigmented lesions on both soles. He had noticed the first lesion 1 year earlier, and it had grown gradually (). The patient's medical history included a 10-year history of diabetes mellitus and a 3-year history of diabetic nephropathy and hypertension. He had been on regular peritoneal dialysis to treat chronic renal failure for 2 years. In addition, there were swelling, crusts, and scars on both lower extremities that had been diagnosed as stasis dermatitis and treated with topical steroids for 2 years (). On physical examination, deep gray-colored, non-tender, non-fluctuant linear patches were noted along the arch of the sole, with no ulcerations or nodules. There were reddish-brown patches, edema, and crusts on the shin, and some hyperpigmented crusted plaques on the knee. The laboratory examination, including a complete blood cell count and differential, platelets, fibrinogen, serum electrolytes, chemical analyses, and liver function tests were within normal limits, except for increased blood urea nitrogen (33.1 mg/dl) and creatinine (6.4 mg/dl) levels. Human immunodeficiency virus antibody was negative. Examination for the immune status, such as the Th/Ts ratio in peripheral blood, C3, C4 and immunoglobulin quantization, and sensitization with allergens, was not done. The skin of the sole and shin was biopsied. The specimen from the sole showed numerous dilated, anastomosing slit-like vascular spaces throughout the entire dermis (). The vascular structures were lined by a single layer of endothelium and there was diffuse extravasation of erythrocytes. Immunohistochemical staining for HHV-8 was strongly positive in the spindle-shaped cells and vascular endothelial cells (). The specimen from the shin showed proliferating dilated capillaries and fibroblasts with diffuse dermal edema (). The vascular slits and atypical endothelial cells were absent in this lesion. The sole lesions were diagnosed as KS and the shin lesions as stasis dermatitis.\nThe sole lesions were treated with cryotherapy and the shin lesions with topical steroid. After one cycle of cryotherapy, the patient was lost to follow-up.