Kaposi sarcoma in an immunocompromised adolescent: A case report from Libreville University Hospital (Gabon)

Introduction: Kaposi sarcoma (KS) is a multifocal vascular tumor driven by human herpesvirus-8 (HHV-8). It is a major opportunistic malignancy in the HIV era in sub-Saharan Africa. In children and adolescents, KS is uncommon but often presents with aggressive, disseminated disease.

Objective: To describe a case of disseminated Kaposi sarcoma in a Gabonese adolescent living with HIV and to highlight key diagnostic and therapeutic challenges.

Case presentation: A 16-year-old girl, diagnosed HIV-positive in 2023 following cerebral toxoplasmosis, had poor adherence to antiretroviral therapy. Both parents had died from AIDS. She was admitted with febrile seizures. Physical examination revealed a temperature of 39 °C; angiomatous nodules on the face (tip of the nose, forehead); violaceous macules on the palate; widespread papules; and bilateral cervical lymphadenopathy. Neurological examination showed no focal deficit. Laboratory tests demonstrated severe pancytopenia with hemoglobin 6.5 g/dL, leukopenia at 900/mm³ and platelets at 16,000/mm³. Immunovirological assessment showed a CD4 count of 22 cells/µL and a viral load of 386,000 copies/mL. Skin biopsy confirmed Kaposi sarcoma. Abdominopelvic ultrasound and computed tomography revealed generalized lymphadenopathy, imaging features compatible with pulmonary involvement and suspected ovarian involvement. Management consisted of antiretroviral therapy with tenofovir-lamivudine-dolutegravir (TDF/3TC/DTG), antifungal therapy (fluconazole, miconazole), and transfusions of packed red blood cells and platelet concentrates. Bleomycin chemotherapy was considered but withheld due to profound thrombocytopenia. The clinical course was marked by rapidly progressive diffuse hemorrhagic manifestations (gingival bleeding, epistaxis), diffuse myalgias, facio-limb edema, and dyspnea. Death occurred on day 48 of hospitalization from acute respiratory failure.

Conclusion: This case illustrates the severity and rapid progression of disseminated Kaposi sarcoma in an HIV-infected adolescent with very low CD4 counts and poor adherence to ART. Early diagnosis, prompt optimization of antiretroviral therapy and tailored psychosocial support are essential to reduce mortality in pediatric and adolescent populations.