Are Corticosteroids Truly Contraindicated in Pulmonary Kaposi Sarcoma?

Kaposi sarcoma (KS) is an angioproliferative disorder associated with human herpes virus 8 (HHV-8) infection. It has both cutaneous and extracutaneous manifestations. With extracutaneous manifestations, it most commonly involves the oral cavity, gastrointestinal tract, and regional lymph nodes. Visceral organ involvement other than the gastrointestinal tract, such as the liver, lungs, and bones, is extremely rare. Here, we would like to discuss a patient with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) found to have pulmonary KS manifesting as acute hypoxemic respiratory failure (AHRF), along with bilateral pleural effusions and endobronchial lesions confirmed on bronchoscopy. He was treated with corticosteroids and paclitaxel, with significant improvement in AHRF. Traditionally, corticosteroids have been associated with exacerbation of pre-existing KS and even development of new-onset KS in HIV-infected patients and induction of KS. The experience gained from this case report suggests that judicious use of corticosteroids may improve the outcome of pulmonary dysfunction in HIV/AIDS-associated KS patients.