PMC6125769_01
CXR PA and lateral view on initial presentation showing coarse bilateral interstitial and perihilar infiltrates.
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CD4 count 54/mm, and HIV viral load 334,991 copies/mL. Chest radiograph (CXR) showed coarse bilateral lower lung interstitial infiltrates and mild perihilar infiltrates (Fig. 1).
High resolution CT scan showing diffuse irregular opacities with interlobular septal thickening.).
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High resolution chest CT (Fig. 2) was performed which revealed diffuse irregular opacities of varying appearance with linear and nodular features, mixed confluent and nodular soft tissue and interlobular septal thickening.
(A) - Atypical spindle cell proliferation in the dermis; H&E 4x. (B)- Atypical spindle cells forming slit-like vascular spaces, lymphoplasmacytic infiltrate, and extravasated red blood cells; H&E 40x. (C)- CD34 immunostain is expressed in tumor cells; IHC 40x. (D)- Nuclear HHV8 immunostain is expressed in the atypical spindle cell proliferation IHC 40x. (E)- Atypical spindle cell proliferation in the lung parenchyma; H&E 4x. (F)- Atypical spindle cells forming slit-like vascular spaces, lymphoplasmacytic infiltrate, and extravasated red blood cells; H&E 40x. (G) CD34 immunostain is expressed in tumor cells; IHC 10x. (H) Nuclear HHV8 immunostain is expressed in the atypical spindle cell proliferation IHC 40x.).
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The right middle lobe lung biopsy revealed multifocal perivascular atypical spindle cell proliferation staining strongly positive for HHV-8 Latency Associated Nuclear Antigen. (Fig. 3) He was diagnosed with AIDS related KS and was started on ART therapy.