Kaposi Sarcoma Herpesvirus Inflammatory Cytokine Syndrome-like Clinical Presentation in Human Immunodeficiency Virus-infected Children in Malawi

Area of Science:

• Pediatric Infectious Diseases
• Oncology
• Virology

Background:

• Human immunodeficiency virus (HIV) infection in children can lead to opportunistic infections and malignancies.
• Kaposi sarcoma (KS) is a known complication of HIV, but KS-associated herpesvirus (KSHV) inflammatory cytokine syndrome is a severe manifestation.
• Limited data exists on KSHV inflammatory cytokine syndrome in pediatric populations, particularly in resource-limited settings.

Purpose of the Study:

• To describe the clinical presentation and laboratory findings of children with HIV and Kaposi sarcoma meeting criteria for KSHV inflammatory cytokine syndrome.
• To highlight the severity and specific clinical features of this syndrome in pediatric patients.

Main Methods:

• Case series describing 7 pediatric patients.
• Clinical data collection including symptoms, physical examination findings, and laboratory results.
• Plasma analysis for KSHV viral load and cytokine levels (interleukin 6) in a subset of patients.

Main Results:

• Seven Malawian children with HIV and Kaposi sarcoma were identified.
• All patients presented with persistent fevers, bulky lymphadenopathy, massive hepatosplenomegaly, and severe cytopenias.
• Plasma analyses in 2 patients revealed extremely elevated KSHV viral load and interleukin 6 levels.

Conclusions:

• KSHV inflammatory cytokine syndrome is a severe, potentially life-threatening condition in children with HIV and Kaposi sarcoma.
• The syndrome is characterized by significant systemic inflammation, organomegaly, and hematologic abnormalities.
• Prompt recognition and further research into management strategies are warranted.