Laryngeal Kaposi's Sarcoma Triggered by Immune Reconstitution Inflammatory Syndrome Successfully Resected With Preoperative Arterial Embolization: A Case Report.

Abstract

Kaposi's sarcoma (KS) is a vascular neoplasm associated with human herpesvirus-8 infection and is common in HIV-infected individuals. Immune reconstitution inflammatory syndrome (IRIS) following antiretroviral therapy (ART) may paradoxically unmask or exacerbate KS. Laryngeal involvement is extremely rare and carries a high risk of bleeding, posing diagnostic and therapeutic challenges. We report a 34-year-old HIV-positive man who developed rapidly progressive laryngeal KS shortly after initiating ART, consistent with IRIS-associated KS. The patient presented with severe supraglottic obstruction requiring tracheostomy. Preoperative selective transarterial embolization of the feeding superior laryngeal artery was performed prior to transoral tumor resection. This study was conducted under the ethical oversight of the National Hospital Organization Kyushu Medical Center (Approval No. 22C005), and individual informed consent was waived due to retrospective data anonymization. Preoperative embolization resulted in marked tumor shrinkage, enabling complete and nearly bloodless excision. Histopathological and immunohistochemical analysis confirmed KS. The patient experienced no recurrence during follow-up. Preoperative transarterial embolization is a feasible and effective adjunct in managing laryngeal KS associated with IRIS, particularly in cases with airway compromise and high bleeding risk. This strategy may facilitate safe surgical intervention in highly vascular tumors.