Serosanguineous pleural effusions in AIDS-associated Kaposi's sarcoma

We describe the clinical course and pleural fluid findings in patients with AIDS-associated pleural KS and survival analysis of cases from the Colorado registry with and without pleuropulmonary KS. Twenty-one of 105 (20 percent) of AIDS cases with KS had pleuropulmonary involvement with KS and 13 (62 percent) had pleural effusions. All cases were homosexual males with cutaneous lesions of KS that antedated pleural involvement by several months. Clinical presentation and physical examination findings were nonspecific. Chest roentgenograms generally showed nonloculated bilateral pleural effusions; concurrent parenchymal infiltrates were present in 90 percent. Pleural fluid analysis showed that most effusions were serosanguineous, mononuclear cell-predominant exudates. Pleural fluid was visibly blood-tinged in nine of ten cases, with median RBC counts of 52,000/microliters (range 16,000 to 803,000/microliters). Cytologic examination of pleural fluid or needle biopsy of the parietal pleura failed to establish the diagnosis. In two cases the effusions were chylous. Postmortem examination of the lungs typically showed multiple cherry red to purple lesions on the visceral but not parietal pleural surface. In half the cases progressive pleural effusions led to significant morbidity or mortality. Systemic chemotherapy for disseminated KS was minimally effective; chest tube thoracostomy with attempted tetracycline sclerosis was unsuccessful in controlling pleural effusions in three cases. Median survival from diagnosis of KS to death was 205 and 338 days, respectively, for patients with and without pleuropulmonary KS (p less than 0.01). Pleural effusions are common in AIDS-associated pleuropulmonary KS, and finding a serosanguineous exudative effusion in an AIDS patient with cutaneous KS is highly suggestive of the diagnosis of pleural KS.