Purple palatal lesions in an HIV-positive patient
38-year-old male
§Chief complaint
Purple patches on the palate that are enlarging
§Medical & dental history
- 01HIV positive, poor antiretroviral adherence, CD4 count 92 cells/uL
- 02Recurrent oral candidiasis
- 03Irregular attendance; generalised periodontitis
§Clinical examination
- 01Multiple violaceous macules and nodules on the hard palate and maxillary gingiva
- 02Some lesions ulcerated with contact bleeding
- 03Concomitant pseudomembranous candidiasis
- 04Generalised lymphadenopathy
§ figuresFigures (2)
Fig. 1This HIV-positive patient presented with an intraoral Kaposi’s sarcoma lesion with an overlying candidiasis infection. This AIDS patient exhibited a CD4+ T-cell count <200, and a high viral load. Initially, the KS les
“Kaposi’s sarcoma intraoral AIDS 072 lores” · Photo Credit: Sol Silverman, Jr., D.D.S. Content Providers: CDC/ Sol Silverman, · Public domain · Wikimedia Commons
Fig. 2This HIV patient presented with labial and gingival Kaposi’s sarcoma secondary to his AIDS infection which included the maxilla. In approximately 7.5-10 percent of AIDS patients display signs of oral Kaposi’s sarcoma, an
“KaposisSarcomaFromCDC03-18-06” · Photo Credit: Sol Silverman, Jr., D.D.S. Content Providers: CDC/ Sol Silverman, · Public domain · Wikimedia Commons
Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Kaposi Sarcoma figures pending faculty review.
§Differential diagnosis
§Final diagnosis
AIDS-associated (epidemic) Kaposi sarcoma of the oral cavity
Multifocal violaceous lesions in a profoundly immunosuppressed patient are Kaposi sarcoma until biopsy proves otherwise; HHV-8 (LANA-1) immunostaining confirms it and separates it from vascular mimics.
§Investigations
- 01Incisional biopsy with HHV-8 LANA-1 immunohistochemistry
- 02CD4 count and HIV viral load
- 03Staging for visceral and cutaneous involvement
- 04Screening for other opportunistic infections
§Treatment plan
- 01Optimise antiretroviral therapy — the single most effective intervention
- 02Local therapy: intralesional vinblastine or radiotherapy for symptomatic oral lesions
- 03Systemic chemotherapy for widespread or visceral disease
- 04Treat candidiasis and provide periodontal care
§Histopathology report
Proliferation of spindle cells forming slit-like vascular spaces with extravasated erythrocytes and haemosiderin, plasma cell infiltrate. HHV-8 LANA-1 positive. Kaposi sarcoma.
§Follow-up & outcome
- 01Marked regression of oral lesions after 6 months of effective antiretroviral therapy
- 02CD4 rose to 310 cells/uL
- 03Residual lesions treated with intralesional vinblastine
§Clinical pearls / learning points
- 01Oral Kaposi sarcoma may be the first presentation of undiagnosed HIV — offer testing.
- 02Immune reconstitution alone often produces substantial regression.
- 03Palatal and gingival sites are the most frequent oral locations.
§References
- WHO Classification of Head and Neck Tumours, 5th ed. (2022).
§Similar cases
41 cases in the library