Kaposi’s sarcoma, syphilis and neurocryptococcosis in an HIV-positive patient

Abstract

Human immunodeficiency virus (HIV) infection has become a worldwide public health problem in recent decades. The main characteristic of HIV is the suppression of the immune system by attacking CD4+ T lymphocytes, which weakens the immune system and makes the individual susceptible to opportunistic infections, secondary neoplasms, and neurological diseases. This study aims to report and discuss the case of an HIV-positive patient who presented concomitantly Kaposi’s Sarcoma (KS), primary syphilis, and neurocryptococcosis, all HIV-related. This is a 31-year-old male patient who sought care at the reference hospital with violaceous skin lesions on the face, upper limbs and chest, with a three-month evolution. Dermatological examination showed infiltrative erythematous-violet plaques, with regular, elevated, scaly edges and varying diameters. He obtained positive serology for anti-HIV and VDRL antibodies, initiating antiretroviral therapy (ART) and treatment protocols for primary syphilis. The patient returned to the service 30 days after hospital discharge, complaining of severe headache, refractory to analgesia with opioids, associated with persistent vomiting. Cranial computed tomography was performed and did not demonstrate alterations; later CSF puncture showed the presence of cryptococcus. A therapeutic scheme for neurocryptococcosis was started, and two other CSF punctures were performed to relieve the pain. This report agrees with the medical literature, reaffirming that HIV-positive patients present a greater predisposition to conditions such as KS, syphilis,
and neurocryptococcosis. Thus, the study illustrates with uniqueness the simultaneous occurrence of complex clinical manifestations in the same immunosuppressed patient.