Kaposi's sarcoma revealing an immune restoration syndrome

Introduction: Highly active antiretroviral therapy (HAART) leads to reconstitution of immune responses in HIV-infected patients. This immune reconstitution may reveal an immune reconstitution syndrome (IRS). While tuberculosis is the most common manifestation of IRS in southern countries, other more serious conditions such as Kaposi's disease may reveal it.

Observation: We report a case of Kaposi's disease revealing an immune restoration syndrome with the aim of contributing to a better management. The patient was 38 years old and HIV1 positive, severely immunocompromised with a TCD4 lymphocyte count of 138 cells/mm3. He was admitted to the YO University Hospital for fever associated with a progressive deterioration of the general condition. On admission, he showed signs of anemic cardiomyopathy (functional systolic murmur + edema of the lower limbs + severe anemia at 4.7g/dl) and signs of functional renal failure (creatinine=182 micromol/l). Under treatment, the evolution was favorable and he was discharged from the hospital on antiretroviral treatment (ARV). Three months after the start of ARV treatment, the follow-up assessment noted an increase in TCD4 lymphocytes to 300 cells/mm3 and the skin examination revealed Kaposi's lesions on the thigh. With specific treatment, the evolution was favorable.

Conclusion: Early detection and management of HIV infection can prevent some serious manifestations of immune restoration syndrome, such as Kaposi's disease.