Site Under Construction

Paradoxical immune reconstitution inflammatory syndrome (IRIS) of Kaposi sarcoma in an HIV-infected African man



Introduction: The immune reconstitution inflammatory syndrome (IRIS) is a reaction that occurs against persistent infectious or non-infectious antigens upon initiation of highly active antiretroviral therapy (HAART).

Case Summary: We report a case of an African male with Kaposi Sarcoma (KS) localized on his right leg as an initial presentation of HIV infection. One month after starting HAART, there was increase in leg edema and rapid worsening of his leg lesions which was consistent with KS-associated IRIS. After assessment for dissemination, the patient continued treatment with HAART without chemotherapy.

Conclusion: KS-associated IRIS should not be mistaken as failure of treatment with HAART. Continuing therapy with HAART alone together with careful monitoring in a patient classified as good risk may be a beneficial option in resource limited situations.



Coo, ER & Lacuesta-Gutierrez, MP (2017). Paradoxical immune reconstitution inflammatory syndrome (IRIS) of Kaposi sarcoma in an HIV-infected African man. Journal of the Philippine Dermatological Society, 26(2), 74-77.



Kaposi Sarcoma, KS, Immune reconstitution inflammatory syndrome, IRIS

  1. Bower M, Nelson M, Young AM, Thirlwell C, Newsom-Davis T, Mandalia S, et al.Immune reconstitution inflammatory syndrome associated with Kaposi’s sarcoma. J Clin Oncol. 2005;23:5224-8.
  2. Müller M, Wandel S, Colebunders R, Attia S, Furrer H, Egger M. Immune reconstitution inflammatory syndrome in patients starting antiretroviral therapy for HIV infection: a systematic review and meta-analysis. Lancet Infect Dis. 2010;10(4):251–61.
  3. Letang E, Naniche D, Bower M, Miro JM.Kaposi sarcoma-associated immune reconstitution inflammatory syndrome: in need of a specific case definition. Clin Infect Dis. 2012;55:157-158.
  4. Philippine Dermatological Society Health Information System. Philippine Dermatological Society. C2011 . Available by request from
  5. Du M, Bacon CM, Isaacson PG. Kaposi sarcoma‐associated herpesvirus/human herpesvirus 8 and lymphoproliferative disorders. J Clin Pathol. 2007;60(12):1350-1357. doi:10.1136/jcp.2007.047969.
  6. La Ferla L, Pinzone MR, Nunnari G, Martellotta F, Lleshi A, Tirelli U, et al. Kaposi’ s sarcoma in HIV-positive patients: the state of art in the HAART-era. Eur Rev Med Pharmacol Sci. 2013;17(7):2354-2365.
  7. Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K. Fitzpatrick’s Dermatology in General Medicine. 8th ed. New York: McGraw-Hill; 2012.
  8. Grayson W, Pantanowitz L. Histological variants of cutaneous Kaposi sarcoma. Diagn Pathol. 2008;3:31. doi:10.1186/1746-1596-3-31.
  9. Satta R, Fresi L, Cottoni F. Dermoscopic rainbow pattern in Kaposi’s sarcoma lesions: our experience. Arch Dermatol.2012;148(10):1207-1208. doi:10.1001/archdermatol.2012.2204
  10. Okuku F, Orem J, Kafeero J, Phipps W, Kamya MR, Casper C. Evaluation of the AIDS clinical trials group staging criteria for Kaposi Sarcoma in a resource limited setting. Infect Agent Cancer. 2012;7(Suppl 1):P8. doi:10.1186/1750-9378-7-S1-P8.
  11. Uldrick TS, Whitby D. Update on KSHV-epidemiology, Kaposi sarcoma pathogenesis, and treatment of Kaposi sarcoma. Cancer Lett. 2011;05:150-162.
  12. Murdoch DM, Venter WD, Van Rie A, Feldman C. Immune reconstitution inflammatory syndrome (IRIS): review of common infectious manifestations and treatment options. AIDS Res Ther. 2007;4:9. doi:10.1186/1742-6405-4-9.
  13. Cattelan AM, Mattiolo A, Grassi A, Piano MA, Sasset L, Trevenzoli M, et al. Predictors of immune reconstitution inflammatory syndrome associated with Kaposi’s sarcoma: a case report. Infect Agent Cancer. 2016;11:5. doi:10.1186/s13027-016-0051-3.
  14. Melé-Ninot G, Sola-Ortigosa J, Quintana-Codina M, Iglesias-Sancho M, Delás-Amat J, Salleras-Redonnet M. AIDS-Related Kaposi’s sarcoma and associated immune reconstitution inflammatory syndrome. Clin Microbiol. 2016;5:236. doi:10.4172/2327-5073.1000236.
  15. Mosam A, Shaik F, Uldrick TS, Esterhuizen T, Friedland G, Scadden D, et al. A randomized controlled trial of HAART versus HAART and chemotherapy in therapy-naïve patients with HIV-associated Kaposi sarcoma in South Africa. J Acquir Immune Defic Syndr. 2012;60(2):150-157. doi:10.1097/QAI.0b013e318251aedd.
  16. Volkow P, Cesarman-Maus G, Garciadiego-Fossas P, Rojas-Marin E, Cornejo-Juárez P. Clinical characteristics, predictors of immune reconstitution inflammatory syndrome and long-term prognosis in patients with Kaposi sarcoma. AIDS Res and Ther. 2017;14:30. doi:10.1186/s12981-017-0156-9.

More Articles

REquesting Permission

Paradoxical immune reconstitution inflammatory syndrome (IRIS) of Kaposi sarcoma in an HIV-infected African man