Abstract: TH-PO1052
A Wolf in Sheep's Clothing: Visceral Kaposi Sarcoma Masquerading as Post-Transplant Lymphoproliferative Disorder After Kidney Transplantation
Session Information
- Transplantation: Clinical - Outcomes, Malignancy, and Pathology
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Parmar, Parth Pravinchandra, University of Florida, Gainesville, Florida, United States
- Mehta, Rohan V., University of Florida, Gainesville, Florida, United States
- Gajjar, Prachi, University of Florida, Gainesville, Florida, United States
- Kumar, Sameet, University of Florida, Gainesville, Florida, United States
- Schamber, Logan Nguyen, University of Florida, Gainesville, Florida, United States
- Joseph, Megan S., University of Florida, Gainesville, Florida, United States
Introduction
Kaposi sarcoma (KS) is a human herpesvirus-8 (HHV-8)–associated angioproliferative neoplasm. It has 400–500-fold higher incidence in kidney transplant recipients (KTR), especially with calcineurin inhibitors use. Prognosis is worse with visceral involvement.
Case Description
A 71-year-old male with deceased donor kidney transplantation (KT), antithymocyte globulin induction and tacrolimus/mycophenolate maintenance presented one year post-KT with progressive renal failure, anasarca, and dialysis dependence. Allograft biopsy showed microvascular inflammation without rejection; steroids and immunoglobulin were ineffective. Imaging revealed retroperitoneal lymphadenopathy suspicious for post-transplant lymphoproliferative disorder (PTLD). Lymph node biopsy confirmed Kaposi sarcoma (KS) with HHV-8 LANA-1 positivity; EBER, CD30, and clonal B cells were negative, excluding PTLD. Bronchoscopy showed endobronchial lesions consistent with pulmonary KS. HHV-8 PCR was 121,000 copies/mL; ganciclovir was given until unquantifiable. Tacrolimus was switched to everolimus and liposomal doxorubicin was stopped after 2 cycles due to declining status, complicated by tracheostomy-dependent respiratory failure and ongoing dialysis.
Discussion
This case highlights visceral KS with high HHV-8 viremia mimicking PTLD without cutaneous lesions. Elevated HHV-8 with anasarca raised concern for KSHV-associated inflammatory cytokine syndrome. This underscores the importance of early tissue diagnosis, HHV-8 viral load assessment, and high suspicion in KTR with unexplained lymphadenopathy, supporting pre-transplant HHV-8 screening.
Violaceous lesion at the level of Carina seen on Bronchoscopy