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+A 34-year-old Hispanic male without significant past medical history presented to our hospital with a one month history of cough; productive of whitish sputum.
+At presentation, he denied fever, chills, night sweats, chest pain, hemoptysis, back pain, recent travel or sick contacts.
+He reported that he had approximately a 15–20 pound weight loss during the last six months.
+He denied smoking, socially drank alcohol, and had unprotected sexual intercourse with multiple partners in the past.
+On admission, his temperature was 97.9°F; heart rate was 85 beats per minute, respiratory rate was 16 breaths per minute, blood pressure was 107/66 mm Hg, and oxygen saturation was 100% on room air.
+Examination showed oral thrush, decreased breath sounds and crackles on the right lower lung base.
+No cutaneous lesions were reported and the rest of clinical examination was unremarkable.
+His complete blood count (CBC) showed hemoglobin of 9.7 g/dL, WBCs 2.3×109/L, and platelets of 164×109/L.
+His creatinine was 0.62 mg/dL, and blood urea nitrogen was 10 mg/dL.
+Radiograph of the chest showed extensive right and left perihilar opacity more on the right side, and computed tomography (CT) scan of the chest showed a right sided large perihilar mass (Figure 1) with multiple thoracic and lumbar vertebrae, ribs, and sternal tiny lytic lesions consistent with bony metastasis (Figure 2).
+Blood and sputum cultures were negative.
+Tuberculosis was ruled out by three consecutive negative sputum smears for acid fast bacilli and a negative QUANTIferon gold test.
+He tested positive for human immunodeficiency virus (HIV) and his CD4 counts came back at 7 cells/uL.
+He was started on prophylaxis with bactrim 80–160 mg daily and azithromycin 1200 mg weekly for opportunistic infections.
+Bronchoscopy with biopsy was performed but was unrevealing and he underwent a video assisted mediastinoscopy with biopsies of the right hilar mass.
+Pathology showed spindle cells positive for CD34, BCL2, vimentin, and HHV-8 with diffuse positivity for CD31 diagnostic of KS.
+He started treatment with HAART in the form of emtricitabine and tenofovir disoproxil fumarate 200/300 mg and dolutegravir 50 mg.
+The patient was actively involved in decisions regarding management options.
+He favored HAART isolated regimen without additional chemotherapy.
+His condition showed continuing clinical improvement; a repeat CT scan of the chest at three months showed profound regression of the disease with disappearance of most of the lesions (Figure 3).