The 67-year-old man with history of atrial fibrillation and aspirin related gastric ulcer bleeding, gout. He was diagnosed with Kaposi sarcoma, bilateral lower extremities, classic type in 2021/02 and received radiotherapy. On 2021-04, he was admitted due to right foot cellulitis and gout attack, recovery after antibiotics treatment. He has been admitted on 2021/11/19 due to fever and shock. Initial empirical ceftriaaxone for R/O salmonellosis and suspected adrenal insufficiency. Fever and shock status is getting much better after hydrocortisone treatment. However, progressive anemia and thrombocytopenia were found, BM exam was noted, but negative finding. Thrombocytopenia was recovery during OPD follow up. Two weeks later, he suffered from fever again, Lab data revealed WBC 5200, HB 9.7 g/dL and PLT 45k/uL. CT scan showed multiple lymphadenopathy over axillary, pectoral, cervical, supraclavicular, He hesitated for LAP biopsy, discharged and taken steroid. The platelet count was recovery during OPD FU. However, he suffered from fever again afater 2 weeks. He was admission. PE showed bilateral axillary palpable lymph nodes. and lymph node biopsy was done on 2021/12/26.