Immune Reconstitution Causing Regression of Kaposi’s Sarcoma

Objective Examine whether conservative management of invasive Kaposi’s sarcoma of the maxilla during immune reconstitution can prevent or reduce the need for surgical intervention. Method We report an unusual case of a patient who presented to a tertiary care medical center with newly diagnosed acquired immunodeficiency syndrome and an erosive mass of the maxilla as demonstrated by both clinical and radiographic examinations. Results The patient underwent an incisional biopsy of the hard palate mass. Immunohistochemical analysis demonstrated the tumor cells to be immunoreactive with CD34 and CD31 and negative for factor VIII, consistent with the diagnosis of Kaposi’s sarcoma. Following biopsy the patient was followed with serial exams while his CD4 count and viral load were monitored throughout the initiation of HAART (highly active antiretroviral therapy). After reconstitution of the immune system and decrease in viral load, the lesion demonstrated significant regression and symptomatic improvement. Conclusion Invasive Kaposi’s sarcoma, although rare, can be a locally aggressive and destructive lesion. Treatment of this disease has centered on surgical removal, chemotherapy, and radiation therapy. However, we demonstrate a case report in which observation in the acute setting has led to significant regression of the disease during immune reconstitution.