A 48-year-old Arab woman presented with a purple rash on the dorsal and palmar aspects of her feet, as well as on her shins, which had first appeared 2 years prior (Fig. 1). At the time, she did not seek medical attention, attributing the lesions to her history of multiple sclerosis (MS) or possible treatment-related side effects. Her 18-year history of multiple sclerosis was managed with corticosteroids. Over the following 2 years, the lesions progressively enlarged. Skin biopsy was eventually performed, confirming the diagnosis of Kaposi’s sarcoma.
Lesions disappeared totally after treatment
Following the histopathological confirmation of Kaposi sarcoma, a comprehensive workup was performed to rule out underlying immunosuppression. Serological testing for human immunodeficiency virus (HIV-1/2) was negative. Further immunological screening revealed no other evidence of a primary or acquired immunodeficiency.
For staging, magnetic resonance imaging (MRI) of the brain was conducted to rule out metastasis. Although no metastases were detected, the MRI revealed demyelinated subcortical plaques in the cerebellum (Fig. 2) , consistent with her known MS. Multislice computed tomography (MSCT) of the chest, abdomen, and pelvis showed no evidence of distant metastasis.
Brain MRI showing demyelinated subcortical plaques consistent with multiple sclerosis. Coronal (left) and axial (right) FLAIR-weighted images demonstrate multiple hyperintense lesions (red arrows) within the periventricular and subcortical white matter, characteristic of demyelinating plaques. No evidence of intracranial metastasis was detected
In light of the diagnosis of iatrogenic Kaposi sarcoma, the suspected causative agent—systemic corticosteroids—was discontinued prior to initiating chemotherapy. The patient’s multiple sclerosis had been managed with corticosteroids for 18 years, but she remained off all immunosuppressive therapy from the start of her Kaposi sarcoma treatment onward. Systemic therapy for KS was indicated due to the progressive and symptomatic nature of the lesions. While pegylated liposomal doxorubicin is often a first-line agent, it was unavailable in our region at the time of treatment. Therefore, the patient was initiated on weekly paclitaxel.
The patient was initiated on weekly paclitaxel 100 mg, with a favorable clinical response observed after 2 months of treatment (Fig. 3). However, due to conflict-related circumstances, she was switched to vincristine, which was associated with significant adverse effects, including constipation and a general decline in her health, accompanied by disease progression. Subsequently, treatment was changed to oral vinorelbine, which also failed to control the disease. Given the lack of response and logistical challenges, paclitaxel was resumed once it became available again.
Histology slides showing spindle-shaped hypercellular tumor with an intermediate nuclear atypia rate. Immunohistochemically showed positivity for cluster of differentiation 34 and calretinin in the tumor cells
Subsequently, paclitaxel was resumed at the same dose weekly, continued for a total of 60 cycles. During this time, the patient reported gradual improvement in both her cancer symptoms and MS-related complaints. She eventually discontinued treatment.
Notably, following the cessation of corticosteroids, the patient reported no clinical relapse of her multiple sclerosis over the subsequent 2-year follow-up period. Follow-up MRI showed persistent MS-related findings but no evidence of metastasis or new lesions, and 2 years after discontinuing therapy, the patient remained in good overall health.