Kaposi s sarcoma with HHV8 infection and ANCA-associated vasculitis in a hemodialysis patient

The association between Kaposi s sarcoma (KS) and human herpes virus eight (HHV-8) infection is rarely reported in hemodialysis (HD) patients. We report here the rare association of KS,HHV-8 and hepatitis C virus (HCV) infection as well as syphilis in a HD patient. We report the case of a 72-year-old woman who presented with microscopic polyangiitis with alveolar hemorrhage and pauci-immune necrosing and crescentic glomerulonephritis as well as renal failure requiring HD. Biological tests showed positive HCV and syphilis tests. The patient was treated by HD and intravenous pulse,followed by oral corticosteroids and six cyclophosphamide monthly pulses with remission of the alveolar hemorrhage,but without renal functional recovery as the patient remained HD dependent. Five months after the first treatment administration,she developed extensive purpuric lesions on her lower limbs,abdomen face and neck. A skin biopsy showed KS. The HHV-8 test was positive,with positive polymerase chain reaction-HHV8 in the serum and skin. After immunosuppression withdrawal,the KS skin lesions regressed rapidly without relapse after 12 months of follow-up,but alveolar hemorrhage relapsed after 16 months of follow-up. Our case showed that the immunosuppressed state related to multiple factors such as aging,vasculitis,HHV-8,HCV,syphilis,immunosuppressive therapy and HD may all have contributed to the development of KS in our patient.