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A 57-year-old man underwent cadaveric renal transplantation in January 2018 and was prescribed mycophenolate mofetil, tacrolimus, and prednisolone as post-transplant immunosuppressive therapy. He developed multiple cervical lymphadenopathies at 6 months after transplantation. Fine needle aspiration cytology of the left submandibular lymph node, performed in the private sector, revealed only a hypocellular lesion. Considering the possibility of a post-transplantation lymphoproliferative disorder, excisional biopsy was arranged in our unit, but the patient defaulted from his appointment. The patient attended the emergency department 9 months after transplantation complaining of shortness of breath. Physical examination on admission revealed generalised lymphadenopathy. Chest radiograph showed left lower, left middle, and right lower zone infiltrates. Despite the use of empirical piperacillin/tazobactam and withholding of mycophenolate mofetil, his condition deteriorated with worsening type one respiratory failure and increasing bilateral lung infiltrates on serial chest radiographs. Tacrolimus was discontinued. However, serial procalcitonin levels were undetectable. Computed tomography scan of the thorax suggested focal consolidative changes with diffuse cervical, axillary, mediastinal, hilar and abdominal lymphadenopathy (Fig 1). Biopsy of the groin and cervical lymph node showed spindle cell proliferation associated with surrounding vascular channels, red cell extravasation between spindle cells (Fig 2a), and positive human herpesvirus 8 (HHV-8) staining (Fig 2b). This confirmed the diagnosis of Kaposi’s sarcoma (KS). There was no plasmablastic histopathology to suggest the presence of multicentric Castleman disease. Despite maximum supportive therapy with mechanical ventilation, empirical antimicrobials and antifungal treatment, his condition further deteriorated and he succumbed due to respiratory failure.

Kaposi’s sarcoma presenting with multiple cervical lymphadenopathies in a renal transplant recipient: a case report