Photo Rounds

Painful growths

An 88-year-old man asked his family physician (FP) to look at a number of painful growths on his left foot. He was originally from Italy, but had been living in the United States for many decades. He had hypertension, but no other health problems. The growths appeared vascular, with a reddish purple color.

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A shave biopsy revealed Kaposi's sarcoma (KS). The patient denied risk factors for human immunodeficiency virus (HIV), saying he was happily married for more than 60 years. The physician still ordered an HIV test, which came back negative.

Classic Kaposi’s sarcoma was first described among older Mediterranean men. Other types of KS include endemic KS (young men in sub-Saharan Africa), epidemic KS (acquired immune deficiency syndrome [AIDS] patients), and post-transplant KS (organ recipients). In the United States, 95% of patients with KS also have AIDS. The prevalence of classic KS in the general population of southern Italy is 2.5/100,000.

The male to female ratio for epidemic KS in the United States is approximately 50:1. Nearly all patients with KS have antihuman herpes virus antibodies (HHV8). The prevalence of these antibodies varies by geographic region, but is less than 5% in the general population of the United States.

Classic KS is relatively rare in the United States and is often treated with radiation or surgical excision. This patient was given the choice between the 2 treatments and opted for surgical therapy.

Photo courtesy of John P. Welsh, MD, and Herbert B. Allen, MD. The text for Photo Rounds Friday is courtesy of Richard P. Usatine, MD. This case was adapted from: Chumley H. Kaposi’s sarcoma. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:929-932.

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