Management

Eleven weeks before admission, therapy with tenofovir, lamivudine, and

efavirenz was begun.
One week later, the patient was seen in the infectious diseases clinic of
Masachussetts General Hospital for evaluation.
chest radiograph was performed at the time of the initiation of !" and it
revealed no changes.
"he administration of antiretroviral and antituberculous medications was
continued, and do#ycycline, trimethoprim, ulfametho#azole, prednisone, and
o#ygen $%&', administered through a nonrebreather face mask( were added.
"he patient was then placed in on a empirical antituberculosis therapy with
no improvement over a ) month period.
*ecause of this, the likelihood of the patient of having tuberculosis was
decreased unless he develops a resistance to the medications.
*ronchoscopy was performed to the patient which revealed a +nding of
multiple, macular red lesions parallel to his tracheal ring.
On the basis of the result of the bronchoscopy that was done to the patient, a
clinical diagnosis of pulmonary ,aposi-s sarcoma that is probably complicated
by .!./ was made.
"he mainstays of treating widespread ,aposi-s sarcoma in a patient with H.0
infection are !" and chemotherapy.
1hile the patient was receiving !" therapy, the patient ,aposi-s sarcoma
worsened that-s why an additional therapy was really necessary.
2hemotherapeutic options include pegylated do#orubicin, liposomal
daunorubicin, or paclita#el.
He reported full adherence with the !" regimen and noted no change in
his skin lesions during the week he was receiving therapy.
"he patient was started on chemotherapy with do#orubicin, bleomycin, and
vincristine.
He had a dramatic improvement in the +rst 3 days of chemotherapy then the
patient was subse4uently referred to another hospital for ongoing oncologic
care.
"he patient continued to receive !" and maintained an undetectable viral
load.
fter the initiation of chemotherapy with complete resolution by the si#th
cycle, the skin lesions of the patient began to improve.
nother chest radiograph obtained )5 weeks after chemotherapy was begun
showed a return to baseline.
6 weeks after completing the si#th cycle of chemotherapy, new skin lesions
appeared on the right side of the chest of the patient anteriorly and on the
right foot, with swelling of the left eyelid.
*ecause of this, the patient was again referred for further chemotherapy.
1ithin a month after recommencement of chemotherapy, all the lesions
regressed.
"he patient has received a total of nine cycles of chemotherapy and remains
well, with no skin lesions. His last outpatient visit was appro#imately 7
months after presentation.