Pseudo-Kaposi's sarcoma associated with acquired arteriovenous fistula

Pseudo-Kaposi's sarcoma or acroangiodermatitis usually has underlying conditions of increased venous pressure or circulatory abnormality. We experienced two cases of pseudo-Kaposi's sarcoma in patients with acquired iatrogenic arteriovenous fistula from hemodialysis on their forearms. The patients complained of painful swollen crusted vesicles and purple or erythematous patches or plaques on their hands and fingers. Histologic findings included features of pseudo-Kaposi's sarcoma such as proliferations of small vascular spaces with narrow vascular channels lined by spindle cells, extravasated erythrocytes, and hemosiderin deposits. Percutaneous arteriography performed in Case one excluded the possible coexistence of arteriovenous malformation. In both cases, venous pressure and skin surface temperature were increased around the lesions; these may have played important roles in the development of the lesions. Both cases improved after oral erythromycin treatment, which seemed to be safe and effective for pseudo-Kaposi's sarcoma.