Presence of human herpesvirus 8 DNA sequences in renal transplantation-associated pleural Kaposi sarcoma

Objective.--To describe one case of symptomatic skin and pleural Kaposi sar coma (KS) associated with kidney transplantation. Diagnosis was supported b y morphologic study and human herpesvirus 8 (HHV-8) detection in both tissu es. Pulmonary involvement was not present. Design.--The presence of HHV-8 DNA sequences was proved using polymerase ch ain reaction (PCR), Southern blot hybridization, and in situ hybridization. Setting.--Human herpesvirus 8 is found in most KS from patients with and wi thout the acquired immunodeficiency syndrome. Clinically significant pulmon ary infiltration by KS is diagnosed uncommonly antemortem, and pleural dise ase is exceptional. Patient.--A 49-year-old man who had renal transplant with immunosuppressive therapy (tacrolimus and prednisone) and developed a cutaneous KS. A pleura l effusion appeared without pulmonary involvement. Both lesions disappeared when immunosuppressive drugs were suspended, Later, the pleural effusion a nd the cutaneous lesions reappeared. pleural biopsy specimens showed KS inf iltration. Outcome.--The patient refused treatment and was lost to follow-up. Results.--The skin and pleural biopsies showed a proliferation of spindle-s haped cells positive for CD34; The HHV-8 sequences were detected by nested PCR. No amplification was detected in uninvolved skin from the patient or i n peripheral blood mononuclear cells from 10 healthy individuals used as co ntrols. The Southern blot hybridization confirmed these results. Conclusions.--To our knowledge, this is the first report of HHV-8 in sympto matic pleural KS, which was probably associated with immunosuppression afte r kidney transplantation. The demonstration of HHV-8 DNA in biopsy material in the appropriate cells could be diagnostic when the morphologic setting is consistent with KS.