Case presentation
A 43-year-old man first presented to our dermatology clinic in 2014 with
multiple erythematous dome-shaped papules on his right auricle. He has
had these lesions from 6 months before his presentation to our clinic
(Fig. 1a). A biopsy was taken from his auricular papules at that time.
While our most probable clinical impression was Angiolymphoid
hyperplasia with eosinophilia (ALHE) or pseudolymphoma, the microscopic
evaluation was consistent with KS (Fig. 2a-e). Histopathologic
examination of a skin biopsy from the ear showed nodular proliferation
of spindled endothelial cells arranged in intersecting fascicles with
intervening slit and sieve-like vascular channels. There were some
blood-filled vascular spaces between spindle cells with red blood cell
extravasation and patchy infiltrate of lymphocytes and plasma cells
(Fig. 2a, 2b). Some mitotic figures and apoptotic bodies were also
identified. Immunohistochemistry staining reveals positive
immunoreaction of tumor cells for CD31 and CD34 as well as HHV-8 which
show nuclear immunoreactivity (Fig. 2c-e).
Because his lesions were limited to his ear, the lesions were totally
excised (Fig. 1b). In 2018, he presented to our clinics with recurrence
of one solitary papule on his right ear, the papule was totally excised
and the histopathology was consistent with KS again. The patient did not
come back for further evaluation at that time. In April 2020, he
presented to our clinic with the recurrence of papules on his right ear
and the development of an erythematous plaque on his right foot since a
year ago. Two biopsies were taken from his ear and foot lesions that
both were consistent with KS. Routine laboratory evaluations including
complete blood count (CBC), liver and renal function tests were normal
and HIV testing was negative. The patient was otherwise healthy without
any history of immunodeficiency. He was not taking any medication.