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A gangrenous foot
  1. G Singh
  1. Department of Genitourinary Medicine, University Hospital of North Staffordshire NHS Trust, Stoke on Trent, UK; gumed_sot{at}

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    The incidence of Kaposi’s sarcoma in HIV infected individuals has declined since the advent of combination antiretroviral therapy in the mid-1990s. The patient, a 34 year old white homosexual man, presented with a swollen, ulcerated, and infected left foot. Amputation was considered but then an HIV antibody test was performed and this was reported positive with severe immunosuppression (CD4 cell count 20 mm3) and plasma HIV viral load >750 000 copies/ml. A biopsy specimen from the foot lesions confirmed Kaposi’s sarcoma. There were also some small lesions suggestive of Kaposi’s sarcoma in his mouth and right conjunctiva along with widespread psoriasis. There was dramatic improvement after six weeks of antibiotics, a combination of three antiretroviral agents (stavudine, lamivudine, and efavirenz), localised radiotherapy, and treatment for psoriasis. This coincided with a rise in CD4 count and rapid drop in HIV viral load. Six months later, he was wearing a normal shoe and the foot was back to normal.