Hickam’s Dictum Prevails: Kaposi Sarcoma and Primary Effusion Lymphoma in a Person Living With Human Immunodeficiency Virus (HIV) and Human Herpesvirus 8 (HHV-8) Infection

Human immunodeficiency virus (HIV) infection has a plethora of effects on its host, including increased susceptibility to opportunistic infections and increased likelihood of developing HIV-associated malignancies. The combined cellular dysfunction orchestrated by co-infection with oncogenic viruses, such as human herpesvirus-8 (HHV-8) and Epstein-Barr virus (EBV), further amplifies the risk of malignancy in people living with HIV/AIDS (PLHA). We report a rare case of Kaposi sarcoma (KS) and extra cavitary primary effusion lymphoma (EPEL) in a 48-year-old woman with advanced HIV disease on antiretroviral treatment presenting with arthralgia, generalized body weakness, drenching night sweats, cavitary effusions, a violaceous rash on her left leg, as well as generalized lymphadenopathy. This report highlights the shared etiological role of HHV-8 in PLHA with both KS and EPEL. Given the rarity of the dual presentation of these conditions, it shows that the prudent application of Occam's razor may suffice in the majority of cases. However, Hickam's dictum should be applied when such diagnostic dilemmas exist.