Triology of human herpesvirus type-8: A rare and fatal case report of primary effusion lymphoma, Kaposi sarcoma and Kaposi sarcoma-associated herpesvirus inflammatory cytokine syndrome (KICS)

Introduction: Human herpesvirus type-8 (HHV-8), also known as Kaposi sarcoma-associated herpesvirus (KSHV) is associated with Kaposi sarcoma (KS), Primary effusion lymphoma (PEL), Kaposi sarcoma-associated herpesvirus inflammatory cytokine syndrome (KICS), and Multicentric Castleman disease (MCD). PEL is a rare and aggressive disease, commonly presents as malignant effusions in body cavities. KICS is an inflammatory syndrome with poor prognosis. We present a case to enhance the awareness of these novel conditions that can potentially co-exist, and advocate for more research. Case Report: A 32-year-old male with human immunodeficiency virus (HIV) infection and KS, who presented with progressive dyspnea, fatigue, and anasarca. He was found to have bilateral pleural effusion and ascites, and labs showed anemia, thrombocytopenia, hyponatremia, and hypoalbuminemia. Through pleuritic fluid analysis and the presence of HHV-8 in both pleuritic fluid and serum, he was diagnosed with PEL and KICS. Though treated aggressively with chemotherapy, he unfortunately passed away two months after presentation. Conclusion: We presented a case of three rare conditions (KS, PEL and KICS) that are all associated with HHV-8/KSHV, and we also reported the presentation of osteolytic bone lesion that is unusual in any of these three conditions.