DOI: https://doi.org/10.36347/sjmcr.2026.v14i06.061

Pages: 1588-1592

Kaposi sarcoma (KS) is a human herpesvirus 8 (HHV-8)-driven angioproliferative tumour that remains one of the most frequent malignancies associated with human immunodeficiency virus (HIV) infection, even in the era of effective antiretroviral therapy (ART). We report the case of a 52-year-old man with a 7-year history of HIV infection on a tenofovir disoproxil fumarate/lamivudine/dolutegravir (TLD) regimen, with an undetectable plasma viral load but a persistently low CD4+ T-cell count of 250 cells/µL, who presented with violaceous, hyperkeratotic plaques on the dorsum of both feet. Skin biopsy with histopathological and immunohistochemical analysis (HHV-8 nuclear positivity, CD34 positivity of vascular structures) confirmed the diagnosis of Kaposi sarcoma. Staging computed tomography of the thorax, abdomen and pelvis revealed bilateral pulmonary nodular and micronodular lesions of lymphatic distribution, consistent with pulmonary involvement of KS. The patient was referred to oncology and started on systemic chemotherapy, with favourable clinical evolution. This observation illustrates that immune reconstitution under ART is not synonymous with immunocompetence, and that KS staging should systematically include thoracic imaging even in virologically controlled patients with discordant CD4+ recovery.