A 45-year-old man presents to the dermatology clinic with multiple dark red to purple patches on his lower legs, which have gradually increased in number and size over the past six months. He reports mild itching and occasional pain in the lesions but denies any significant bleeding. Recently, he has also noticed some swelling in his legs.

His medical history includes an unexplained weight loss of 7 kg (15 lbs) over the past year, occasional night sweats, and a persistent dry cough. On examination, there are multiple violaceous, non-blanching nodules and plaques scattered on both lower legs, with some extending to the trunk and oral mucosa. There is also mild bilateral lower limb edema.

Given the patient’s symptoms and lesion distribution, further investigations, including an HIV test and CD4 count, are ordered. The HIV test returns positive, with a low CD4 count, confirming advanced immunosuppression. A skin biopsy of one of the lesions reveals spindle cell proliferation with vascular slits, consistent with Kaposi’s sarcoma.

The patient is referred to an infectious disease specialist for antiretroviral therapy (ART) initiation and an oncologist for evaluation of systemic involvement. He is counseled on the need for combination ART as the mainstay of treatment, with additional options such as chemotherapy or radiotherapy for extensive or symptomatic lesions.