Flank pain and cough in a 25 yo

Let’s begin with our case! You have a 25 yo M with history of HIV who presents with flank pain and cough

What is on your differential diagnosis for this patient? What recommendations do you make for working this patient up?

The case raised the broad ddx to consider for pulmonary symptoms in pts with HIV infection. Here is a graphic thinking about it by CD4 count and how to evaluate

Here is similar information but formatted by radiographic appearance

Your patient’s clinical status declines. See below

What changes would you recommend? Would you change antimicrobials?

Final dx ultimately was Kaposi Sarcoma inflammatory cytokine syndrome (KICS)

Check out graphic for features of KS on histopath

A brief review of Kaposi Sarcoma forms. Although you might think about HIV/AIDS-related, remember that this can occur in other settings (e.g. post-transplant).

KSHV or HHV-8 was not discovered until 1994!

https://pubmed.ncbi.nlm.nih.gov/30705286/

A little more information on KSHV/HHV-8 here

Check out this Nature review for a great summary which helped with these infographics:

https://pubmed.ncbi.nlm.nih.gov/30705286/

KSHV can cause lymphoproliferative disorders including primary effusion lymphoma and multicentric castlemans disease

It can also lead to KSHV inflammatory cytokine syndrome (KICS)

2010 paper: https://pubmed.ncbi.nlm.nih.gov/20583924/

Here is a working case definition

The optimal management of KICS is unclear, but often experts trial treatments similar to those used with KSHV-MCD

Check out more in these papers:
https://pubmed.ncbi.nlm.nih.gov/26658701/

https://pubmed.ncbi.nlm.nih.gov/29766014/

Really appreciated the oncology input from @DrKateLurain @ramya_ramaswami ! Twitter really opens doors to learn so much!

Check out below 👇

Remember to 📞 a friend if you are concerned about these entities:

Excellent job by @NNolanMD and @transplantID !!!

Originally tweeted by Infectious Diseases Fellows Network (@ID_fellows) on 1 December, 2020.

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