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Monolesional Kaposi Sarcoma at the Site of Slow Healing Herpes Zoster in an HIV+ Patient: Immunocompromised District in an Immunocompromised Patient

Ruocco, Eleonora MD, PhD*; Valenzano, Francesco MD, PhD; Brunetti, Giampiero MD*; Schwartz, Robert A. MD, MPH‡,§,¶; Ruocco, Vincenzo MD*

The American Journal of Dermatopathology: December 2013 - Volume 35 - Issue 8 - p e139–e142
doi: 10.1097/DAD.0b013e3182a67d74
Extraordinary Case Report

Abstract: Besides the well-known systemic immune deficiency, also a regional immune deficiency, labeled as ”immunocompromised district“ (ICD), has been documented and focused in the recent years. The objective of the study is to gain more insights into the mechanisms involved in systemic and local immune destabilization. A 35-year-old, homosexual, and drug-addicted HIV+ man presented with a single nodule of Kaposi sarcoma (KS) located on the penis, where a slow to heal herpes zoster had appeared 2 months before. It has been assumed that the unusual penile location of herpes zoster facilitated the outbreak of KS in the affected dermatome because of a viral damage to sensory nerve fibers of the same dermatome. This damage, by interfering with the immunoregulatory function of neuropeptides released by nerve endings in that area, may have caused a regional alteration of the immune control favoring the local onset of the ”opportunistic“ angiogenic tumor (KS). In a few words, an ICD took place in an immunocompromised patient, thus introducing a more vulnerable site in an already vulnerable subject. The present case is the second one in the literature to document an ICD in the setting of preexisting systemic immune deficiency.

*Department of Dermatology, Second University of Naples, Naples, Italy;

Department of Dermatology, Catholic University, Rome, Italy; and

Departments of Dermatology,

§Pathology, and

Preventive Medicine and Community Health, Rutgers University, New Jersey Medical School, Newark, NJ.

Reprints: Vincenzo Ruocco, MD, Professor, Department of Dermatology, Second University of Naples, via Sergio Pansini, 5, 80131 Naples, Italy (e-mail:

The authors declare no conflicts of interest.

© 2013 by Lippincott Williams & Wilkins.