Ambreen Moatasim, Anwarul Haque.
Kaposi sarcoma involving axillary lymph nodes.
Int J Pathol Jan ;2(2):95-100.

A 40 years old male, presented with the complaints of low-grade fever, generalized aches, pains and progressive weight loss for the past 4 months. He was also complaining of night sweats, generalized weakness and easy fatigue ability. He had been married for the past 2 yrs and had no children. He gave history of having traveled abroad to Iran 20 years back and stayed there for 4 years. He denied history of sexual contact, blood transfusion or intravenous drug abuse. However he did receive intravenous medication for some illness 20 years ago. There was no record available for the mentioned illness. There was no other significant medical, family or drug history. On examination he was a young man of lean built, lying in bed, pale, conscious and oriented. He seemed to be in agony due to aches and pains. His vital signs were stable. His left submandibular, bilateral axillary, and inguinal lymph nodes were enlarged. Systemic examination did not reveal any significant finding. On laboratory investigations ALT was 46 u/l, HbsAg was negative and anti HCV antibodies were negative. His Blood hemoglobin was 10.9 g/ dl, hematocrit was 31.6%, TLC was 5000/ul and platelets were 151,000/ul. The differential leukocyte count showed 31% lymphocytes, 53% neutrophils and 16% mixed cells. ESR was 74. Chest x-ray was normal. Urine R/E revealed proteins ++ and 13-14 pus cells. Mantoux test and VDRL were both negative. Ultrasound abdomen showed normal study. His axillary lymph node biopsy was sent for histopathology that revealed Kaposi sarcoma. During his hospital stay he developed loose watery diarrhea with high grade fever. Modified ZN stain for cryptosporidium in stools was negative. His HIV screening was done and he was found to be HIV positive by both enzyme immunoassay and particle agglutination test. He had markedly low percentage (i.e. 3%. Normal= 29-57%) and absolute count (i.e. 57. Normal= 430-1010) of CD4+ T- helper cells with reversal of CD4/CD8 ratio.

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