Beyond the Skin: Chylous Pleural Effusion Complicating HIV-Associated Kaposi Sarcoma

Kaposi sarcoma (KS) is an HHV-8-mediated vascular malignancy encompassing four distinct clinical variants: classic, endemic, iatrogenic, and AIDS-associated. While classically indolent, KS can pursue an aggressive course in the context of HIV infection. Pleural involvement, particularly chylous effusion, represents a rare but grave manifestation of the disease. In cases of chylous effusion, pleural fluid analysis typically reveals a triglyceride concentration >110 mg/dL or the presence of chylomicrons, findings that signify true chylous involvement. We report the case of a 33-year-old man with AIDS-associated KS complicated by chylous pleural effusion. The patient was initiated on antiretroviral therapy and received a single dose of chemotherapy, after which he developed biochemical evidence of tumor lysis syndrome 16 days later, leading to fatal clinical deterioration. This case underscores the catastrophic potential of KS complicated by chylous pleural effusion and highlights the importance of vigilance for life-threatening complications during therapy.