Recombinant interleukin 2 monotherapy for classic Kaposi sarcoma.

An 83-year-old Japanese man was referred to our clinic with a 3-year history of multiple cutaneous lesions on both feet, which had slowly increased in size and number. A physical examination revealed scattered blue-red papules up to 5 mm in diameter on both feet, mainly on the soles. The largest domeshaped nodule (10 mm in diameter) was present on the ventral aspect of his right first toe. The inguinal lymph nodes were not palpable. Results of computed tomographic scanning showed no metastatic lesions in the liver or other abdominal organs. The results of laboratory studies were within normal limits, including urinalysis, CD4 and CD8 lymphocyte counts, and CD4/CD8 ratio. Serologic test results for human immunodeficiency virus (HIV) 1 and HIV-2 were negative. The patient had IgG antibodies to cytomegalovirus. He was otherwise healthy except for having hypertension, for which he was taking alacepril. The largest nodule located on his right first toe was excised with 1-cm margins, and the defect was covered by a full-thickness skin graft. A specimen of the excised nodule revealed bland spindle tumor cells forming vascular channels proliferating with slight inflammatory lymphocytic infiltration in the dermis. These clinical and histological findings confirmed the diagnosis of classic Kaposi sarcoma (KS) in stage IIA, according to the classification by Kriegel et al. Multiple dark red papules remained and gradually increased in number and size on both feet about 1 month after the operation (Figure 1). A biopsy specimen of 1 of the papular lesions also showed histological characteristics typical of KS (Figure 2).