Combined classic and iatrogenic Kaposi's sarcoma - Corticosteroid withdrawal can result in remission

A 72-year-old white man of Italian ancestry had a 7-month history of asympt omatic plaques on his legs and feet. The plaques had appeared 1 month after he started taking prednisone, 25 mg daily, for symptoms of temporal arteri tis. The patient had several medical Problems and had been recently hospita lized on account of melena. He had been treated with topical medications fo r seborrheic dermatitis. He had no known drug allergies. Physical examinati on revealed several well-demarcated plaques on both legs, the dorsa and toe s of both feet, and the left sole (figures I and 2). The lesions, which mea sured 1 to 3 cm across, were purple to dusky red and non-blanchable. Some o f the Plaques had minimal scale. No lesions were seen in the oral mucosa. Microscopic examination of the scaly lesions using a potassium hydroxide pr eparation revealed no fungi. Histopathologic examination showed extensive r ed blood cell extravasation and a proliferation of superficial dermal spind le cells forming dilated, slitlike, jagged vascular channels separating col lagen (figure 3). These findings are diagnostic of Kaposi's sarcoma. The le sions improved markedly after two courses of radiation therapy, each consis ting of 15 Gy over a 10-day period, and tapering of prednisone from 25 mg t o 5 mg daily. The lesions resolved completely after a third course of radiation therapy. After 2 years, the lesions are still in remission.