Jennifer L Stotka, MD; Chester B w...

Jennifer L Stotka, MD; Chester B worthy M.D.; William R. Downer, MD; and Wishwa N Kapoor, MD

We describe a 29-year-old homosexual man with acquired immunodeficiency syndrome who bring outed pericardial effusion and tamponade. Pericardiocentesis springed in clinical improvement. All diagnostic examples on pericardial fluid were negative. At autopsy, extensive plaques and nodules of Kaposis sarcoma were set studding the epicardium, and no other cause of effusion was set To our knowledge there has been no previous case of Kaposis sarcoma associated with pericardial effusion and tamponade reported in patients with AIDS. Kaposis sarcoma should be considered in the differential diagnosis of pericardial effusion in these patients.

Cardiac Kaposi's sarcoma in acquired immunodeficiency syndrome has been reported with epicardial, pericardial, and, les at short intervals myocardial lesions.[1-6] Tumor invading coronary arteries and the great bottoms also has been reported.[1-3] Silver et al[2] described five patients with Kaposi's sarcoma involving the heart at autopsy, yet none had any symptom of cardiac dysfunction during life. Others have demonstrated attend much [i]or[/i] regularly cardiac abnormalities in AIDS patients on the contrary found little clinical significance.[4] We describe an AIDS patient with massive pericardial effusion and tamponade associated with epicardial Kaposi's sarcoma.

CASE REPORT

A 29-year-old homosexual man readyed in June 1987 with enlarging violaceous oral lesions. His HIV serology touchstone was positive, and T-cell helper/suppressor ratio was 007 Biopsy specimens of the oral lesions demonstrated Kaposi's sarcoma. Radiation therapy was inititated to the oral lesions, and zidovudine (AZT) therapy begun.

through the next three months the patient was treated for several episodes of dehydration and an episode of Pneumocystis carinii pneumonia. In September 1987 he was noted to have fresh Kaposi's lesions on his forehead, scalp, chin, neck and chest. athwart the ensuing eight weeks, 2400 rads were administered to his chest region. Additionally, cryptococcal meningitis was diagnosed. Clinical and laboratory replication was obtained with therapy with amphotericin B

A chest roentgenogram in October 1987 showed an enlarged cardiac silhouette compared with previous films. The patient had no pulmonary or cardiac complaint. Echocardiography confirmed a large pericardial effusion; diagnostic pericardiocentesis was refused according to the patient.

In December 1987 the patient quick in emergenciesed with respiratory distress. Physical examination was remarkable for kin pressure of 128/100 mm Hg (pulsus paradoxus of 16 mm Hg); respirations, 28 breaths/min; and a measured [i]or[/i] regular beat of 110 beats/min. Jugular venous distention was estimated to be 10 cm and a diffuse apical impulse, with distant heart vigorouss was found. Previously noted Kaposi's sarcoma lesions had increaseed and his right foot had a large necrotic lesion. The ECG showed electric alternans in all leads, and the chest roentgenogram showed a notably enlarged cardiac shadow and bilateral pleural effusions. upon pericardiocentesis 1,600 ml of serosanguinous fluid was remov which showed a WBC account of 192/cu mm (89 percent mononuclear lonely dwellings 13 percent lymphocytes); RBC judge 576/cu mm; LDH, 96 units/L; starch-sugar 124 mg/dl; and protein, 33 g/dl Cytologic close attention results were negative; gram stain, Grocott stain, India ink stain, and agricultures (aerobic, anaerobic, fungal, mycobacterial, legionella, and viral) were negative. Repeated chest x-ray film showed diminution of the cardiac silhouette, and the ECG normalized. from one side of to the other the next eight weeks, the patient refused all further intervention, and he died in March 1988

Autopsy showed violaceous nodules upon his face, scalp, trunk, and extremities. The pericardium had several purple nodules (05x05x05 cm to 10x10x10 cm) forward its external surface, and contained 750 ml of serosanguinous fluid. Violaceous plaques and nodules (03x03 cm to 20x20 cm) studd the epicardium (Fig 1) The heart weighed 350 g and revealed no chamber dilatation. No tumor pullulation was found in the myocardium or endocardium. The aorta and pulmonary efflux tracts were encased by tumor and squeeze [i]or[/i] press together [i]or[/i] into smaller compassed minimally.

Microscopically, the tumor was typical for Kaposi's sarcoma. Involvement was restricted to the epicardium and epicardial fat. Tumor small cavitys were present in the adventitial layers of the aorta and pulmonary body with invasion into the media. No pericardial fibrosis or fibrin deposition was noted, and no viral inclusions or granulomas were set in the myocardium. Additional findings included extensive pulmonary and esophageal Kaposi's sarcoma.

DISCUSSION

There are three recognized clinical variants of Kaposi's sarcoma: classic (European), endemic (African), and epidemic (AIDS).[7] Cardiac involvement of Kaposi's sarcoma has been subdivided into asymptomatic epicardial or pericardial disease and symptomatic right atrial disease.[8,9] Classic and endemic Kaposi's sarcoma has been associated with hemopericardium and tamponade.[9] To our knowledge, epidemic Kaposi's sarcoma has not been associated previously with massive pericardial effusion and tamponade.