Case #83: The lump on the gum
This 36-year-old gay man was recently diagnosed with HIV on routine medical check up. As his CD4 count was <250 cells, he was started on HAART. Except for some itchy skin rash, he tolerated the HAART well and his CD4 improved. He noticed a lump on the upper jaw which has been progressively increasing in size. It is not painful. He thought it is an abscess and decided to poke it with a needle. The lesion bled but there is no pus.
Here is a (blur) photo of the lesion:
Questions:
1. What is the diagnosis?
2. What is the etiological agent?
3. Why did he develop the lesion?
Mon, 290609 @ 0700
Categories: Patient of the Week
Answers:
1. Karposi sarcoma (the gum or palate is one of the common sites of this vascular tumor). KS is almost exclusively seen in gay people in HIV medicine.
2. HHV8 is the etiological agent.
3. This man was started on HAART. Prior to that he did not have this lesion. Opportunistic infection after commencing HAART is now a noted phenomenon. This is attributed to Immune Reconstitution Syndrome/Disease (acronyms include: IRIS, IRS, IRD); a still-to-be-properly defined syndrome.
Good try TFTD and CK. No one else is brave enough to try this question. And for that both of you deserve a kudo each.
1. Kaposi Sarcoma. (The pix is very similar with the one in wikipedia.)
2. Human herpesvirus 8.
3. Kaposi Sarcoma is considered an opportunistic infection. It occurs in patient with weakened immune system. This man was recently diagnosed to have HIV with a CD4 count of less than 250 cells.
just out of curiosity, how come you didn’t use gloves during the examination?
err… that’s the patient’s own hands in the photo.
1. Kaposi sarcoma (Lesion appears to be a single reddish nodule at the upper gum)
2. Kaposi Sarcoma herpes virus
3. His CD4 count is less than 250 & he was recently diagnosed with HIV infection. Kaposi sarcoma is usually associated with CD4 counts lesser than 200 cells. Usually, it occurs at the mouth region, on the hard palate, gingiva, soft palate etc areas which are common. The lesion is which is rupture by the patient himself confirms that the nodule is angiomatous of origin which lead to the suspicion of Karposi Sarcoma. Look out for other areas like gastrointestinal & respiratory involvement.
(Boss… photo does not appear on the blog, need to click on the empty area to see the picture, please rectify it.)
Thanks for highlighting the error, CK. It has been corrected.