RT Book, Section
A1 Nair, Vinay
A1 Yaskiv, Oksana
A1 Bijol, Vanesa
A1 Lipton, Alexander
A1 Bhaskaran, Madhu
A1 Molmenti, Ernesto P
A2 Molmenti, Ernesto Pompeo
SR Print(0)
ID 1194189359
T1 Kaposi Sarcoma of the Urinary Bladder
T2 Molmenti’s Kidney and Pancreas Transplantation: Operative Techniques and Medical Management, 2e
YR 2023
FD 2023
PB McGraw Hill
PP New York, NY
SN 9781260474275
LK accesssurgery.mhmedical.com/content.aspx?aid=1194189359
RD 2024/04/19
AB 44  year  old  female  with  a  diagnosis  of  IgA  nephropathy  and  FSGS  (focal  segmental  glomerulo  sclerosis)  who  underwent  a  live  donor  kidney  transplant.  Post-operatively  she  was  treated  for  a  borderline  acute  cellular  rejection  with  C4d  positivity.  Seven  months  post-transplant  she  presented  with  a  urinary  tract  infection  that  progressed  to  complaints  of  dysuria,  flank  pain,  and  fullness  over  the  allograft  despite  broad-coverage  antibiotics.  A  CT  scan  showed  bladder  thickening  at  the  site  of  implantation  of  the  ureter  and  retro-peritoneal  lymphadenopathy  (Figures  112-56–112-58).  Biopsy  of  the  bladder  and  of  an  enlarged  lymph  node  revealed  a  spindle  cell  neoplasm  with  prominent  vascular  channels  filled  with  red  blood  cells.  Immunohistochemical  stains  confirmed  Human  Herpes  Virus-8  (HHV-8)  in  the  neoplastic  cells  and  the  diagnosis  of  Kaposi  sarcoma  (Figures  112-62–112-65).Initial  treatment  was  discontinuation  of  tacrolimus  and  mycophenolate  mofetil,  remaining  only  on  5  mg  daily  of  prednisone.  Pegylated  liposomal  doxorubicin  was  started.  By  the  fourth  cycle,  all  symptoms  had  resolved.Follow-up  CT  scans  of  the  abdomen  and  pelvis  showed  complete  resolution  of  the  findings  (Figures  112-59–112-61).Currently  she  is  on  low  dose  sirolimus  and  5  mg  prednisone  with  a  normal  creatinine.This  case  is  especially  interesting  because  it  occurred  in  a  female,  had  no  dermatologic  manifestations,  and  involved  the  bladder.As  exemplified  here,  in  the  setting  of  immunosuppression  all  lesions  should  be  biopsied  unless  a  diagnosis  is  evident  and  undisputable.