Our 70-year-old male patient is followed for a bacteriologically proven lung tuberculosis. One month after starting treatment, there were emergence of nodular lesions on the extremities in context of fever, and alteration of general state of health, prompted the subject to halt the antibacillary treatment.
In clinical examination on admission, cutaneous findings included sore infiltrated purplish papulonodular lesions on both the forearms (Figure 1(a)), with a rapid extension on the two hands (Figure 1(b)). Papillomatous, palmoplantar skin lesions, as well as important lymphedema of the extremities were also observed (Figures 1(c) and 1(d)). Pleuro-pulmonary examination showed no abnormality and the rest of physical assessment had no peculiarities.
Biologically, the patient had a normochromic, normocytic anemia with a hemoglobin level of 10, 5 g/dl, a white blood cell count of 8520/mm3 and a lymphocytopenia level of 700 per mm3. The C-reactive protein was at 94 mg/l and the erythrocyte sedimentation rate was at 45 mm in the 1st hour. The search for Koch's bacillus (Mycobacterium tuberculosis) on direct examination was negative. Serological assays for HBV (viral hepatitis B), HCV (viral hepatitis C), and HIV (human immunodeficiency virus) were negative as well.
Cutaneous biopsy revealed proliferation of fusiform and vascular cells with extravasation of blood associated with occasional siderophages (Figure 2). Immunohistochemical studies resulted in Kaposi's Sarcoma.
The patient has been placed for two months under a four-drug anti-tuberculosis regimen made from Isoniazid (H/Inh), Rifampin (R/Rif), Pyrazinamide (Z/Pza), and Ethambutol (E/Etb), followed by a dual therapy based on Isoniazid and Rifampin. After two months, the clinical outcome was favourable with an improvement of the general condition, a decrease in the extent of skin lesions' and a partial regression of lymphedema starting from the fourth month of treatment.