Saint Michael's Medical Center Newark, NJ, United States
Raed Atiyat, MD, Hamid Shaaban, MD, Theodore Dacosta, MD, Mehul Shah, MD, Yatinder Bains, MD Saint Michael's Medical Center, Newark, NJ
Introduction: Kaposi sarcoma is a vascular tumor that affects multiple organs including the skin, mucous membranes lining the mouth, pharynx, respiratory tract, lymph nodes and gastrointestinal tract. Kaposi sarcoma is associated with human herpesvirus 8 infection (HHV-8). There are 4 forms of Kaposi sarcoma that have the same pathological process but manifest differently. The Variant discussed in this case is the epidemic (AIDS associated) form, which is seen in one fourth of all AIDS patients and is the most common AIDS associated tumor in the United States.
Case Description/Methods: A 34-year-old male presented to the emergency department (ED) with rectal bleeding, decreased appetite, and 40 pound weight loss over three month period. He denied any other GI symptoms. Family history was negative for GI cancers. In the ED, vitals were unremarkable. Laboratory studies were significant for human immunodeficiency virus (HIV) antibody, HIV-1 quantity by NAAT 118,255 Copies/ML, CD4 236 /uL. Hepatitis panel and testing for other sexually transmitted diseases were unremarkable. Physical exam was notable for supraclavicular and inguinal lymphadenopathy, multiple purple non-blanchable lesions on the lower extremities and trunk, a mass on hard palate, and palpable mass in the rectum. CT abdomen and pelvis showed a rectosigmoid neoplasm with perirectal, inguinal, and retroperitoneal lymphadenopathy. CT chest revealed pulmonary metastasis. Colonoscopy revealed ileitis, a nodule in the descending colon, and mass in the rectosigmoid which were subsequently biopsied. Pathology of the biopsy of the descending colon nodule was positive for (HHV-8) immunostaining. Rectal mass was positive on HHV-8 immunostaining confirming diagnosis of colonic Kaposi sarcoma. Patient was initiated on highly active antiretroviral therapy (HAART) and 6 cycles of liposomal doxorubicin with excellent clinical response and weight gain. Repeat colonoscopy a year later, demonstrated remission on histopathology.
Discussion: We propose that primary colonic kaposi sarcoma without cutaneous manifestation be included in the differential diagnosis of HIV/AIDS patients that present with lower gastrointestinal bleeding. If there is a high clinical suspicion, there may be a role for early endoscopic screening in newly diagnosed AIDS patients to increase the likelihood of early diagnosis and aiding early management of this aggressive disease. Early diagnosis is necessary to initiate early treatment and achieve improvement in clinical outcomes.
Figure: Figure A. Polyps appreciated throughout the Colon
Raed Atiyat indicated no relevant financial relationships.
Hamid Shaaban indicated no relevant financial relationships.
Theodore Dacosta indicated no relevant financial relationships.
Mehul Shah indicated no relevant financial relationships.
Yatinder Bains indicated no relevant financial relationships.
Raed Atiyat, MD, Hamid Shaaban, MD, Theodore Dacosta, MD, Mehul Shah, MD, Yatinder Bains, MD. P0225 - Kaposi Sarcoma With Colonic Involvement Without Cutaneous Manifestations as Initial Presentation of AIDS, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.