Lymphadenopathy, pneumonia, and HIV—a common trio, an uncommon outcome

The AIDS epidemic in Africa has resulted in a huge increase in the incidence of HIV-associated KS. Coincident with the increase in maternal KS, is a ten-fold increase in paediatric KS.1 To date, only two case reports have described the simultaneous occurrence of KS in mother-child pairs.2,3 Children with HIV-associated KS typically present with generalised lymphadenopathy. Because of the high prevalence of dual HIV/TB infections in sub-Saharan Africa, children are often misdiagnosed as having TB. This is compounded by difficulties in visualising early patch-stage KS in dark-skinned patients. Hence, generalised lymphadenopathy with haematological and chest radiograph abnormalities is usually attributed to TB, until proven otherwise and patients started on empirical anti-TB treatment. The above scenario is notable in sub-Saharan Africa where a high prevalence of all three infections-HHV-8, Mycobacterium tuberculosis, and HIV co-exist. This report highlights the importance of a lymph node biopsy in HIV-infected African children with generalised lymphadenopathy, who are unresponsive to anti-TB therapy. This procedure ensures a timely diagnosis and start of appropriate therapy. Although KS is a clinical AIDS-defining condition and an entry point to antiretroviral therapy, pathological confirmation is crucial. In addition, the provision of antiretroviral therapy in Africa requires the following basic laboratory services: rapid HIV testing, lymphocyte count, haemoglobin, and periodic referral for viral loads.