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Granulomas in acquired immunodeficiency syndrome-associated cutaneous Kaposi sarcoma: evidence for a role for Mycobacterium tuberculosis

Authors

  • Pratistadevi K. Ramdial,

    Corresponding author
    1. Department of Anatomical Pathology, National Health Laboratory Service, Durban, KwaZulu Natal, South Africa
    2. Department of Anatomical Pathology, Nelson R Mandela School of Medicine, University of KwaZulu Natal, KwaZulu Natal, South Africa
      Pratistadevi K. Ramdial
      Department of Anatomical Pathology, Level 3, Laboratory Building, Inkosi Albert Luthuli Central Hospital, 800 Bellair Road, Mayville, 4058 KwaZulu Natal, South Africa
      Tel: +27 (0)31 2402693
      Fax: +27 (0)31 2402610
      e-mail: ramdial@ukzn.ac.za
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  • Yetish Sing,

    1. Department of Anatomical Pathology, National Health Laboratory Service, Durban, KwaZulu Natal, South Africa
    2. Department of Anatomical Pathology, Nelson R Mandela School of Medicine, University of KwaZulu Natal, KwaZulu Natal, South Africa
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  • Sumeshini Subrayan,

    1. Department of Anatomical Pathology, National Health Laboratory Service, Durban, KwaZulu Natal, South Africa
    2. Department of Anatomical Pathology, Nelson R Mandela School of Medicine, University of KwaZulu Natal, KwaZulu Natal, South Africa
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  • Eduardo Calonje,

    1. Department of Dermatopathology, St John's Institute of Dermatology, St Thomas's Hospital, London, UK
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  • Jamila Aboobaker,

    1. Department of Dermatology, Nelson R Mandela School of Medicine, University of KwaZulu Natal, KwaZulu Natal, South Africa
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  • Clive Sydney,

    1. Department of Anatomical Pathology, National Health Laboratory Service, Durban, KwaZulu Natal, South Africa
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  • Dinesh Sookdeo,

    1. Department of Anatomical Pathology, National Health Laboratory Service, Durban, KwaZulu Natal, South Africa
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  • Amsha Ramburan,

    1. Department of Anatomical Pathology, National Health Laboratory Service, Durban, KwaZulu Natal, South Africa
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  • Thandinkosi E. Madiba

    1. Department of Surgery, Nelson R Mandela School of Medicine, University of KwaZulu Natal, KwaZulu Natal, South Africa
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Pratistadevi K. Ramdial
Department of Anatomical Pathology, Level 3, Laboratory Building, Inkosi Albert Luthuli Central Hospital, 800 Bellair Road, Mayville, 4058 KwaZulu Natal, South Africa
Tel: +27 (0)31 2402693
Fax: +27 (0)31 2402610
e-mail: ramdial@ukzn.ac.za

Abstract

Background: Co-lesional acquired immunodeficiency syndrome-associated cutaneous Kaposi sarcoma (AIDS-KS) and Mycobacterium tuberculosis-associated granulomatous inflammation are undocumented.

Method: Retrospective appraisal of skin biopsies with co-lesional AIDS-KS and microscopic tuberculosis (TB).

Results: Sixteen biopsies from nine males and seven females form the study cohort. Histological assessment confirmed nodular and plaque KS in 12 and 4 cases each, respectively. Necrotizing, non-necrotizing and a combination of necrotizing and non-necrotizing granulomatous inflammation were present in nine, two and five biopsies each, respectively. The identification of acid fast bacilli on Ziehl-Neelsen staining and M. tuberculosis on polymerase chain reaction confirmed co-lesional TB in 15/16 biopsies. Co-lesional AIDS-KS and lichen scrofulosorum, hitherto undocumented, were confirmed in one biopsy. The histopathological findings served as a marker of human immunodeficiency virus (HIV) infection, visceral TB, therapeutic noncompliance and multidrug resistant pulmonary TB in nine, eight, five and one patient, respectively. M. tuberculosis was cultured from sputum or nodal tissue of all patients.

Conclusion: Granulomatous inflammation in KS requires optimal histopathological and molecular investigation to confirm an M. tuberculosis origin. The cutaneous co-lesional occurrence of AIDS-KS and microscopic TB may serve as the sentinel clue to HIV infection, systemic TB, therapeutic noncompliance or multidrug resistant TB.

Ramdial PK, Sing Y, Subrayan S, Calonje E, Aboobaker J, Sydney C, Sookdeo D, Ramburan A, Madiba TE. Granulomas in acquired immunodeficiency syndrome-associated cutaneous Kaposi sarcoma: evidence for a role for Mycobacterium tuberculosis.

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