Atypical Ocular Kaposi Sarcoma in a Middle-Aged Male with Retroviral Disease: A Case Report

Abstract

Kaposi sarcoma is a vascular neoplasm strongly associated with human herpesvirus 8 infection and is frequently encountered in patients with poorly controlled human immunodeficiency virus infection. Ocular involvement is uncommon and may be overlooked when it resembles benign eyelid or conjunctival lesions. This case report describes an atypical and advanced presentation of bilateral ocular Kaposi sarcoma in a 47-year-old man with known HIV infection and poor adherence to antiretroviral therapy. The patient presented with bilateral ocular masses of several months’ duration. The lesions began as small, painless nodules on the upper eyelids, then rapidly enlarged and became ulcerated and fungating. Multiple nodular lesions were also present on the face and arms. His retroviral status was confirmed, and an incisional biopsy was performed. Histopathological examination showed spindle cell proliferation, slit-like vascular spaces and extravasated red blood cells, consistent with Kaposi sarcoma. He was recommenced on antiretroviral therapy and referred for dermatology and ophthalmology care. Chemotherapy with bleomycin and vincristine was planned, but he received only a single dose of vincristine because of financial constraints and was subsequently lost to follow-up. He later returned with worsening symptoms, weight loss, weakness, cough and dyspnoea, and died shortly thereafter. This case highlights the aggressive clinical course that may occur when Kaposi sarcoma develops in the setting of poor adherence to antiretroviral therapy.