Unsuccessful treatment of Kaposi’s sarcoma immune reconstitution inflammatory syndrome Natalia Regina Martins, Nurimar Fernandes Federal University of Rio de Janeiro - Brazil INTRODUCTION OBJECTIVE Immune Inflammatory Syndromes (IRIS) is a pathological inflammatory reaction that can develops oncologic and opportunistic infections after the use of Highly Active Antiretroviral Therapy (HAART). Kaposi’s sarcoma (KS) sill the most frequent disease and triggers an exuberant immune response with considerable morbidity and mortality. While lesions normally resolve upon initiation of HAART, recrudescence or unmasking of KS lesions may occur by this time. Treatment of unmasking KS-IRIS is not yet standardized. To report the unsuccessful treatment of a patient with fulminating mucocutaneous KS-IRIS by maintaining HAART and using Paclitaxel. CASE REPORT A 64-year-old man previously healthy was diagnosed HIV-positive after an intense bronchopneumonia and hemoptysis. HAART was initiated with Lamividina, Tenofovir, and Atazanavir/Ritonavir. After 12 weeks, his CD4 cell had increase from 1 cells/ul to 204cells/ul, and developed breathlessness, progressive bilateral painless cervical adenopathy, down limbs lymphedema and multiple papulonodular red colored lesions associated with edema. Skin biopsy of a leg lesion showed a late-stage vasoformative involving both dermis and subdermis, with areas erythrocyte extravasation and the presence of multiple hyaline bodies and some vascular invasion (Figures 1, 2). Nuclei of the spindle cells stained positively for HHV-8 antigen immunohistochemistry confirming Kaposi’s sarcoma secondary to IRIS (Figure 3). After one week, cutaneous and oral lesions had disseminated rapidly. HAART was maintain and treatment with Paclitaxel commenced. The patient did not respond well to Paclitaxel 100mg/m2/ week. After three weeks the symptoms worsened. Ascites, pleural effusion, renal insufficiency and pulmonary sepsis led to clinical deterioration and ventilator support, dying shortly after. CONCLUSIONS Very low CD4 count strongly predicted KS and is been reported as a common manifestation of IRIS among patients with an AIDS-defining clinical condition. It is probably that progressive lung Kaposi’s sarcoma was initially misdiagnosed as a bronchopneumonia. This case emphasizes the need for clinicians and dermatologists to be thoughtful to the possibility of pulmonary KS in HIV infected patients with skin manifestation. Pulmonary KS have a high mortality rate, unfortunately even with systemic chemotherapy. [email protected] The authors have no conflict of interest HUCFF-UFRJ