Brooklyn Hospital Center Brooklyn, NY, United States
Jasparit Minhas, MD, Praneeth Bandaru, , Jamil M. Shah, MD, Manan A. Jhaveri, MD, Leonard Berkowitz, MD, Denzil Etienne, MD Brooklyn Hospital Center, Brooklyn, NY
Introduction: Kaposi sarcoma caused by Human herpes virus 8 (HHV-8) is a low-grade vascular tumor mostly seen in immunocompromised individuals such as patients with AIDS, organ transplant patients or patients with immunosuppressive therapy. In contrary to the commonly reported cases of Kaposi sarcoma in immunocompromised patients, we report a case of Kaposi Sarcoma in the setting of an HIV infection who is virologically suppressed and high CD4 count.
Case Description/Methods: 51-year-old male with past medical history significant for well controlled HIV, uncontrolled Diabetes Mellitus type 2, CKD- 2 with no active complaints underwent screening colonoscopy and incidentally found to have Kaposi sarcoma. Negative for any opportunistic infections or AIDS defining illness. Examination was negative for any skin or mucocutaneous lesions. Labs were significant for undetectable HIV viral load and CD4 count of 840. Colonoscopy is notable for 5mm tubular adenoma in the ascending colon, polypoid lesion in rectum (Figure 1). Pathology from rectal polyp showed clusters of monomorphic spindle cells with focal vasoformation centered in submucosa consistent with Kaposi sarcoma. IHC stains revealed spindle cells positive for CD31, Vimentin and negative for Desmin, SMA, S 100, Pan-CK likely seen in Kaposi Sarcoma. Also, diffusely positive for ERG and HHV-8. Given that the HIV is controlled and patient is without any signs or symptoms, it is unlikely the patient will require further treatment.
Discussion: Kaposi sarcoma is a multifocal angioproliferative tumor associated with HHV-8 infection, first described by Dr. Kaposi in 1872. Kaposi sarcoma is classified into 4 categories: 1. Classic (Mediterranean), 2. Endemic (African), 3. Iatrogenic (transplant-related), 4. Epidemic (AIDS associated- most aggressive form). Most reported cases are seen in AIDS defining illness (high viral loads and low CD4 counts) or in patients on long-term immunosuppression. Clinical presentation includes cutaneous lesions and/ or extracutaneous involvement (mucous membranes including gastrointestinal tract, lymph nodes, visceral organs). Definitive diagnosis is made via biopsy along with IHC staining and PCR to detect HHV-8 DNA. Patients with gastrointestinal symptoms are usually referred for endoscopy to evaluate for visceral mucosal involvement. Asymptomatic lesions are usually left untreated. Therapy for symptomatic patients include local options (radiation, cryotherapy, laser ablation, excision), systemic chemotherapy, antiretroviral therapy.
Figure: Figure – 1 Polypoid lesion in rectum
Jasparit Minhas indicated no relevant financial relationships.
Praneeth Bandaru indicated no relevant financial relationships.
Jamil Shah indicated no relevant financial relationships.
Manan Jhaveri indicated no relevant financial relationships.
Leonard Berkowitz indicated no relevant financial relationships.
Denzil Etienne indicated no relevant financial relationships.
Jasparit Minhas, MD, Praneeth Bandaru, , Jamil M. Shah, MD, Manan A. Jhaveri, MD, Leonard Berkowitz, MD, Denzil Etienne, MD. P1288 - Rectal Kaposi Sarcoma in an Immunocompetent Patient, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.