Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Pulmonary involvement in AIDS-related Kaposi sarcoma

Kevin R Flaherty, MD, MS
Section Editor
John G Bartlett, MD
Deputy Editors
Helen Hollingsworth, MD
Sadhna R Vora, MD


AIDS-related Kaposi sarcoma (KS) is a low-grade vascular tumor associated with human herpesvirus 8 (HHV-8), which is also known as the Kaposi sarcoma-associated herpesvirus (KSHV). HHV-8 is also causally linked to primary effusion lymphoma and multicentric Castleman’s disease. The widespread application of potent combination antiretroviral therapy (ART) has led to a striking decrease in the incidence of KS and has changed its natural history [1].

The clinical manifestations, diagnosis, and complications of pulmonary AIDS-associated KS are discussed here. Other aspects of AIDS-related KS are reviewed separately. (See "AIDS-related Kaposi sarcoma: Clinical manifestations and diagnosis" and "AIDS-related Kaposi sarcoma: Staging and treatment" and "Virology, epidemiology, and transmission of human herpesvirus 8 infection", section on 'Virology and pathogenesis'.)


In 80 to 90 percent of cases, pulmonary involvement with KS occurs in conjunction with more extensive mucocutaneous disease [2,3]. However, pulmonary involvement can be the initial manifestation of KS and occurs in the absence of mucocutaneous disease in 15 percent [4].

Pulmonary KS can involve the lung parenchyma, airways, pleura, and/or intrathoracic lymph nodes. There are no unique manifestations that distinguish KS from other pathologic processes in the lungs.

Parenchymal lung involvement is usually manifest clinically by dyspnea, hypoxemia, and dry cough developing over a few weeks [5]. Hemoptysis, fever, fatigue and occasionally respiratory failure can also occur.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Aug 01, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Lodi S, Guiguet M, Costagliola D, et al. Kaposi sarcoma incidence and survival among HIV-infected homosexual men after HIV seroconversion. J Natl Cancer Inst 2010; 102:784.
  2. Haramati LB, Wong J. Intrathoracic Kaposi's sarcoma in women with AIDS. Chest 2000; 117:410.
  3. Huang L, Schnapp LM, Gruden JF, et al. Presentation of AIDS-related pulmonary Kaposi's sarcoma diagnosed by bronchoscopy. Am J Respir Crit Care Med 1996; 153:1385.
  4. Pinzone MR, Berretta M, Cacopardo B, Nunnari G. Epstein-barr virus- and Kaposi sarcoma-associated herpesvirus-related malignancies in the setting of human immunodeficiency virus infection. Semin Oncol 2015; 42:258.
  5. Joshi M, Markelova N, Palacio D, Schapira RM. A patient with HIV, dyspnea, and multiple pulmonary nodules: pulmonary Kaposi sarcoma. Chest 2006; 130:1924.
  6. Zibrak JD, Silvestri RC, Costello P, et al. Bronchoscopic and radiologic features of Kaposi's sarcoma involving the respiratory system. Chest 1986; 90:476.
  7. O'Brien, RF. Pulmonary and pleural Kaposi's sarcoma in AIDS. Semin Respir Med 1989; 10:12.
  8. Davis SD, Henschke CI, Chamides BK, Westcott JL. Intrathoracic Kaposi sarcoma in AIDS patients: radiographic-pathologic correlation. Radiology 1987; 163:495.
  9. Sivit CJ, Schwartz AM, Rockoff SD. Kaposi's sarcoma of the lung in AIDS: radiologic-pathologic analysis. AJR Am J Roentgenol 1987; 148:25.
  10. Garay SM, Belenko M, Fazzini E, Schinella R. Pulmonary manifestations of Kaposi's sarcoma. Chest 1987; 91:39.
  11. Miller RF, Tomlinson MC, Cottrill CP, et al. Bronchopulmonary Kaposi's sarcoma in patients with AIDS. Thorax 1992; 47:721.
  12. Meduri GU, Stover DE, Lee M, et al. Pulmonary Kaposi's sarcoma in the acquired immune deficiency syndrome. Clinical, radiographic, and pathologic manifestations. Am J Med 1986; 81:11.
  13. Roux FJ, Bancal C, Dombret MC, et al. Pulmonary Kaposi's sarcoma revealed by a solitary nodule in a patient with acquired immunodeficiency syndrome. Am J Respir Crit Care Med 1994; 149:1041.
  14. Nathan S, Vaghaiwalla R, Mohsenifar Z. Use of Nd:YAG laser in endobronchial Kaposi's sarcoma. Chest 1990; 98:1299.
  15. Wolff SD, Kuhlman JE, Fishman EK. Thoracic Kaposi sarcoma in AIDS: CT findings. J Comput Assist Tomogr 1993; 17:60.
  16. Hoskote SS, Patel VP. Pulmonary Kaposi sarcoma in AIDS. Mayo Clin Proc 2012; 87:e77.
  17. Gasparetto TD, Marchiori E, Lourenço S, et al. Pulmonary involvement in Kaposi sarcoma: correlation between imaging and pathology. Orphanet J Rare Dis 2009; 4:18.
  18. Yoo DJ, Lee KH, Munderi P, et al. Clinical and bronchoscopic findings in Ugandans with pulmonary Kaposi's sarcoma. Korean J Intern Med 2005; 20:290.
  19. Kaplan LD, Hopewell PC, Jaffe H, et al. Kaposi's sarcoma involving the lung in patients with the acquired immunodeficiency syndrome. J Acquir Immune Defic Syndr 1988; 1:23.
  20. Aboulafia DM. The epidemiologic, pathologic, and clinical features of AIDS-associated pulmonary Kaposi's sarcoma. Chest 2000; 117:1128.
  21. Gill PS, Akil B, Colletti P, et al. Pulmonary Kaposi's sarcoma: clinical findings and results of therapy. Am J Med 1989; 87:57.
  22. Cadranel JL, Kammoun S, Chevret S, et al. Results of chemotherapy in 30 AIDS patients with symptomatic pulmonary Kaposi's sarcoma. Thorax 1994; 49:958.
  23. Dittmer DP, Richards KL, Damania B. Treatment of Kaposi sarcoma-associated herpesvirus-associated cancers. Front Microbiol 2012; 3:141.
  24. Mosam A, Shaik F, Uldrick TS, et al. A randomized controlled trial of highly active antiretroviral therapy versus highly active antiretroviral therapy and chemotherapy in therapy-naive patients with HIV-associated Kaposi sarcoma in South Africa. J Acquir Immune Defic Syndr 2012; 60:150.
  25. Sigel K, Pitts R, Crothers K. Lung Malignancies in HIV Infection. Semin Respir Crit Care Med 2016; 37:267.
  26. Belda J, Canalís E, Gimferrer JM, et al. Subglottic stenosis in an HIV positive patient: an exceptional form of clinical presentation in Kaposi's sarcoma. Eur J Cardiothorac Surg 1997; 11:191.
  27. Lawson G, Matar N, Kesch S, et al. Laryngeal Kaposi sarcoma: case report and literature review. B-ENT 2010; 6:285.
  28. Miner JE, Egan TD. An AIDS-associated cause of the difficult airway: supraglottic Kaposi's sarcoma. Anesth Analg 2000; 90:1223.
  29. O'Brien RF, Cohn DL. Serosanguineous pleural effusions in AIDS-associated Kaposi's sarcoma. Chest 1989; 96:460.
  30. Rubio ER, Chang EE, Kovitz KL. Thoracoscopic management of pleural effusions in Kaposi's sarcoma: a rapid and effective alternative for diagnosis and treatment. South Med J 2002; 95:919.
  31. Nasti G, Talamini R, Antinori A, et al. AIDS-related Kaposi's Sarcoma: evaluation of potential new prognostic factors and assessment of the AIDS Clinical Trial Group Staging System in the Haart Era--the Italian Cooperative Group on AIDS and Tumors and the Italian Cohort of Patients Naive From Antiretrovirals. J Clin Oncol 2003; 21:2876.