PMC6180928_01
The rubbery red and white material expectorated by the patient.
CRIPU2018-9736516.001.jpg
PMC6180928_01_CRIPU2018-9736516.001.jpg
fig1
A 25-year-old Hispanic male with HIV infection (CD4 count <40 cells/muL, viral load 307 copies/mL on antiretroviral therapy) and pulmonary KS on chemotherapy presented with progressive dyspnea and cough productive of rubbery red and white material (Figure 1).
Computed tomography of the chest showed diffuse peribronchovascular consolidative opacities with surrounding ground glass opacities, interlobular septal thickening, and infiltrative soft tissue densities throughout the mediastinum. There is also a linear filling defect in the bronchus intermedius.
CRIPU2018-9736516.002.jpg
PMC6180928_01_CRIPU2018-9736516.002.jpg
fig2
Chest computed tomography showed diffuse peribronchovascular consolidative opacities with surrounding ground glass opacities, interlobular septal thickening, and infiltrative soft tissue densities throughout the mediastinum (Figure 2).
Bronchoscopic image at the level of the main carina with "tissue-like" material evident.
CRIPU2018-9736516.003.jpg
PMC6180928_01_CRIPU2018-9736516.003.jpg
fig3
Bronchoscopy revealed "tissue-like" material within the tracheobronchial tree, forming casts (Figures 3 and 4).
Bronchial cast obtained by flexible bronchoscopy fitting the mold of the right bronchial tree.
CRIPU2018-9736516.004.jpg
PMC6180928_01_CRIPU2018-9736516.004.jpg
fig4
Bronchoscopy revealed "tissue-like" material within the tracheobronchial tree, forming casts (Figures 3 and 4).
Histopathology of the bronchial cast shows fibrin (black arrow) with few leukocytes (white arrow).
CRIPU2018-9736516.005.jpg
PMC6180928_01_CRIPU2018-9736516.005.jpg
fig5
On histopathological analysis, the casts were composed of fibrin with sparse leukocytic infiltrate, consistent with a diagnosis of PB (Figure 5).
Postmortem finding: hepatization of the lung.
CRIPU2018-9736516.006.jpg
PMC6180928_01_CRIPU2018-9736516.006.jpg
fig6
An autopsy revealed extensive pulmonary KS with hepatization of the lung and near obliteration of the normal alveolar architecture with copious mucin and cellular debris within the airways (Figures 6, 7, and 8).
Postmortem finding: longitudinal cross section of a terminal bronchiole filled with mucin and cellular debris.
CRIPU2018-9736516.007.jpg
PMC6180928_01_CRIPU2018-9736516.007.jpg
fig7
An autopsy revealed extensive pulmonary KS with hepatization of the lung and near obliteration of the normal alveolar architecture with copious mucin and cellular debris within the airways (Figures 6, 7, and 8).
Postmortem finding: mucin-filled alveoli surrounded by angiomatous features of Kaposi sarcoma.
CRIPU2018-9736516.008.jpg
PMC6180928_01_CRIPU2018-9736516.008.jpg
fig8
An autopsy revealed extensive pulmonary KS with hepatization of the lung and near obliteration of the normal alveolar architecture with copious mucin and cellular debris within the airways (Figures 6, 7, and 8).