Kaposi Sarcoma of the Tongue with Concomitant Cutaneous Involvement in an HIV-Negative Female Patient: A Case Report

Background: Kaposi sarcoma (KS) is an angioproliferative neoplasm associated with human herpesvirus 8 (HHV-8). It most commonly occurs in immunocompromised individuals, particularly those infected with human immunodeficiency virus (HIV). Oral involvement, especially of the tongue, is uncommon, and its occurrence in HIV-negative patients remains exceptionally rare.
Case Presentation: We report the case of a 54-year-old HIV-negative woman with a six-month history of progressive hyperpigmented cutaneous lesions involving the hands, feet, and thighs, associated with a violaceous angiomatous lesion affecting the anterior two-thirds of the tongue. Clinical examination also revealed cervical, axillary, and inguinal lymphadenopathy. Histopathological examination of a skin biopsy demonstrated a spindle-cell and vascular proliferation suggestive of Kaposi sarcoma. Immunohistochemical analysis confirmed the diagnosis with positive staining for HHV-8 and CD34. An inguinal lymph node biopsy further confirmed nodal involvement by Kaposi sarcoma. Contrast-enhanced computed tomography revealed multiple cervical, axillary, retroperitoneal, and inguinal lymphadenopathies. HIV serology was negative. The patient received weekly paclitaxel at a dose of 80 mg/m² for 12 cycles, achieving an excellent clinical response with significant regression of both lingual and cutaneous lesions and good treatment tolerance.
Conclusion: Lingual Kaposi sarcoma in HIV-negative patients is a rare clinical entity that may present with concomitant cutaneous and nodal involvement. Histopathological and immunohistochemical evaluation remains essential for diagnosis. Weekly paclitaxel represents an effective therapeutic option in advanced disease, providing favorable clinical outcomes. This case highlights the importance of considering Kaposi sarcoma in the differential diagnosis of vascular lesions of the tongue, even in the absence of HIV infection.