Pleural Effusion in an HIV-Positive Patient: A Case Report and Review of Diagnostic Challenges

Human herpesvirus 8 (HHV-8), also known as Kaposi sarcoma-associated herpesvirus (KSHV), causes multiple cancers, particularly Kaposi sarcoma (KS), which continues to be a major health concern for patients with severe HIV/AIDS. When KS affects the lungs, it can create diagnostic difficulties, especially when it appears as chest fluid accumulation without characteristic lesions. We describe an unusual case involving a 27-year-old HIV-positive female patient with skin KS who developed worsening breathing problems and was discovered to have hemorrhagic pleural effusion. Medical imaging showed bilateral massive pleural effusions with adjacent compressive atelectasis. HHV-8 genetic material was identified in the pleural effusion, and surgical examination revealed small nodular growths on the visceral and parietal pleural surfaces; nevertheless, microscopic tissue analysis indicated a reactive, non-cancerous chest lining response. Other infectious and tumor-related causes were eliminated. Treatment with antiretroviral medications and encapsulated doxorubicin resulted in marked clinical improvement. This case highlights the necessity of including widespread KS as a diagnostic possibility in HIV-positive patients presenting with hemorrhagic pleural effusion. Identifying HHV-8 in chest fluid combined with typical clinical characteristics can support the diagnosis. Early treatment with antiretroviral therapy and cancer medications can produce significant clinical improvement.