Non‐Epidemic Kaposi Sarcoma Refractory to Laser Therapy in an HIV‐Negative Man Who Has Sex With Men (MSM)

ABSTRACT Kaposi sarcoma (KS) is a vascular neoplasm associated with human herpesvirus 8 (HHV‐8), typically affecting immunocompromised individuals. However, emerging reports describe cases in HIV‐negative men who have sex with men (MSM), constituting a proposed non‐epidemic variant. We report the case of a 50‐year‐old immunocompetent MSM who presented with violaceous papules on the right foot, histologically confirmed as KS. Extensive workup ruled out systemic involvement and HIV infection. Initial treatment with CO₂ laser achieved partial response, but lesion recurrence prompted additional laser interventions, including pulsed dye laser (PDL), 532‐nm KTP laser and combined PDL/Nd:YAG laser therapy. Despite multiple sessions and varied parameters, no significant clinical improvement was observed, and disease progression continued with new lesions affecting contralateral and distant sites. Ultimately, radiotherapy was administered, achieving complete remission. This case illustrates the diagnostic and therapeutic challenges of non‐epidemic KS. Although laser therapies are increasingly used for localized KS, especially for cosmetic and symptomatic relief, their efficacy remains variable. Our findings align with prior reports demonstrating inconsistent outcomes and high recurrence rates following laser monotherapy. This case underscores the necessity of individualized treatment planning and highlights radiotherapy as an effective option for refractory disease. Furthermore, it emphasizes the need for heightened clinical awareness of KS in HIV‐negative MSM, even in the absence of immunosuppression. Continued investigation is warranted to define optimal treatment strategies for this KS variant and to clarify the role of laser modalities in long‐term disease control.