Am. J. Respir. Crit. Care Med.,
Volume 157, Number 2, February 1998, 458-463
Diagnosis of Pulmonary Kaposi's Sarcoma by Detection
of Human Herpes Virus 8 in Bronchoalveolar Lavage
MICHAEL
TAMM,
FRANK
REICHENBERGER,
CHRISTINE E.
MCGANDY,
ALINE
STALDER,
ANDREAS
TIETZ,
PETER
DALQUEN,
ANDRÉ P.
PERRUCHOUD,
and
GIERI
CATHOMAS
Division of Pneumology and Outpatient Clinic, Department of Internal Medicine and Institute of Pathology,
University Hospital Basel, Basel, Switzerland
Human herpes virus 8 (HHV8) DNA has recently been detected in sarcoma tissue of patients with Kaposi's sarcoma. HHV8 DNA could also be found in bronchoalveolar lavage (BAL) fluid of patients with
tracheobronchial Kaposi's sarcoma. To determine the specificity, sensitivity and predictive values of
HHV8 DNA detection in the BAL for the diagnosis of pulmonary Kaposi's sarcoma, 100 consecutive BAL were prospectively analyzed for the presence of HHV8 DNA using a nested PCR assay. In addition, 19 BAL samples of 14 AIDS patients with cutaneous or visceral Kaposi's sarcoma were retrospectively investigated. The prospective group consisted of 79 BAL performed in immunocompromised
and of 21 BAL in nonimmunocompromised patients. Four patients of the prospectively analyzed
group undergoing six BAL showed tracheobronchial Kaposi's sarcoma at five bronchoscopies. All of
the five BAL samples performed in these patients with endoscopically visible Kaposi's sarcoma were
positive for HHV8 DNA. Following chemotherapy and antiretroviral treatment tracheobronchial Kaposi's sarcoma was no longer detectable at a subsequent bronchoscopy and HHV8 DNA in BAL became negative in one patient. One BAL sample of a HIV-positive patient with no evidence of Kaposi's
sarcoma was HHV8 DNA-positive. The sensitivity, specificity, positive and negative predictive values
of HHV8 detection for the diagnosis of tracheobronchial Kaposi's sarcoma were 100%, 98.9%, 83.3%, and 100%, respectively. Twelve of 19 BAL samples of the retrospective group were HHV8 DNA-positive. In this group, 10 patients undergoing a total of 14 BAL suffered from pulmonary Kaposi's sarcoma. HHV8 DNA was documented in 10 of these 14 BAL samples. In three BAL of this group HHV8
DNA was positive, but pulmonary Kaposi's sarcoma was diagnosed at a later stage. In conclusion, the
detection of HHV8 DNA in BAL is restricted to patients with Kaposi's sarcoma and is highly sensitive
and specific for pulmonary involvement of Kaposi's sarcoma.
