A man in his 30s with an unremarkable medical history presented to the emergency department with facial lesions of several months’ duration. Ophthalmology testing was consulted. Visual acuity was 20/30 OD and 20/20 OS. The right lower eyelid had a lesion, while the remainder of the anterior segment and ophthalmoscopic examination was normal in both eyes (Figure).
A human immunodeficiency virus (HIV) test result revealed the patient was HIV positive, with a CD4+ T-cell count of 76. A diagnosis of Kaposi sarcoma was made and systemic workup revealed pulmonary involvement, which is an unusual presentation of AIDS/HIV in 2016. Biopsy of similar lesions on the patient’s torso confirmed the diagnosis. Antiretroviral therapy and paclitaxel were commenced, with minimal effect on the lesions. External beam radiation is therefore planned, given reported success with recalcitrant skin lesions.1,2 This case highlights the importance of recognizing unusual ocular manifestations of life-threatening infections such as AIDS.
Weinstein JE, Mears KA. Periocular Kaposi Sarcoma as the Initial Presentation of Human Immunodeficiency Virus. JAMA Ophthalmol. 2016;134(10):e162139. doi:10.1001/jamaophthalmol.2016.2139