Pulmonary Kaposi Sarcoma Presenting at a Relatively Preserved CD4 Count with Suspected Immune Reconstitution Inflammatory Syndrome: A Rare Case Report

along with bilateral pleural effusion, radiologically suggestive of pulmonary Kaposi sarcoma (Fig. 3).7,8 Given the differential diagnoses of opportunistic infections, bronchoscopy with bronchoalveolar lavage (BAL) was performed.BAL analysis was negative for Mycobacterium tuberculosis, Pneumocystis jirovecii, cytomegalovirus, fungal pathogens, and bacterial infections.No endobronchial violaceous lesions were visualized during bronchoscopy, a finding reported in a subset of pulmonary KS cases.3,9 A skin biopsy from one of the lesions revealed spindle cell proliferation with slit-like vascular spaces and extravasated red blood cells, consistent with Kaposi sarcoma (Fig. 4). 1 Pleural fluid investigations revealed an exudative lymphocytic picture with low adenosine deaminase (ADA) levels; GeneXpert and cytology were negative.The patient improved symptomatically with supportive care and was discharged with plans for initiation of ART.