Kaposi sarcoma in a female patient with multiple sclerosis: a case report

Kaposi sarcoma is a vascular neoplasm linked to human herpes virus 8 and presents in four main variants. The development of Kaposi sarcoma, particularly the iatrogenic form, in younger women with autoimmune conditions such as multiple sclerosis is exceedingly rare and presents unique diagnostic and therapeutic challenges.

We report the case of a 48-year-old Arab woman with an 18-year history of multiple sclerosis managed with corticosteroids, who developed cutaneous iatrogenic Kaposi sarcoma on her lower extremities. The diagnosis was delayed for 2 years as the lesions were initially misattributed to her underlying multiple sclerosis. A skin biopsy eventually confirmed Kaposi sarcoma, and staging revealed localized cutaneous disease with no visceral involvement. The patient was treated with weekly paclitaxel, showing a favorable response. Due to conflict-related logistical issues, treatment was temporarily switched to vincristine and vinorelbine, which resulted in disease progression and adverse effects. Paclitaxel was successfully reintroduced, leading to sustained clinical improvement, and 2 years after completing therapy, the patient remains in good health with no evidence of Kaposi sarcoma recurrence or multiple sclerosis exacerbation.

This case expands the known clinical and demographic spectrum of Kaposi sarcoma, underscoring the importance of maintaining a high index of suspicion in atypical patient populations to prevent diagnostic delays. The co-occurrence of multiple sclerosis and Kaposi sarcoma underscores the importance of recognizing iatrogenic Kaposi sarcoma in patients receiving immunosuppressive therapy and calls for further research into the complex intersection of autoimmune disorders and iatrogenic treatment-related immune dysregulation in oncogenesis. This report underscores the importance of individualized, persistent therapeutic strategies in managing Kaposi sarcoma.