Virginia Commonwealth University Health System Richmond, VA, United States
Irma Hashmi, DO1, Nikita Chadha, DO2, Joseph Spataro, MD1 1Virginia Commonwealth University Health System, Richmond, VA; 2VCU Health, Richmond, VA
Introduction: Caused by the herpes-virus 8 infection, Kaposi sarcoma (KS) is a low-grade vascular tumor seen in patients with acquired immunodeficiency syndrome (AIDS). Extra-cutaneous manifestations are rare and few reports in the literature cite KS of the gastrointestinal (GI) tract. We present the case of a patient with human immunodeficiency virus (HIV) and weight loss, found to have KS on biopsy of the colon, a rare but interesting finding.
Case Description/Methods: Patient is a 48 year-old-male with past medical history of HIV, prior KS, and anxiety, referred for colonoscopy for weight loss. The patient had reported an unintentional weight loss of approximately 25lb weight loss in the past year. History is notable for nonadherence to antiretroviral therapy. Although the patient had cutaneous manifestations of KS in 2009, he remained asymptomatic until recent evaluation showed concern for recurrent KS lesions on his lower extremities. Pertinent laboratory values included white blood cell 13,000 cells/L, CD4 count 323 cells/mm3; AST 27 IU/ L, ALT 18 IU/L, total bilirubin < 0.2 mg/ dL. The patient underwent colonoscopy with what appeared to be benign, mildly erythematous mucosa in the descending colon (Figure 1). However, pathology returned with proliferation of small vessels lined by bland tumor cells and immunohistochemistry confirming positive stains for HHV-8, CD31 and D2-40 and negative for CK AE1/3, supporting a diagnosis of Kaposi sarcoma.
Discussion: Although KS is often recognized by its violaceous cutaneous lesions, few case reports comment on the extra-cutaneous manifestations of KS, and especially those seen in the GI tract. Interestingly, KS is the most common GI malignancy in AIDS patients. When symptomatic, KS can present with GI hemorrhage, abdominal pain, nausea, and even weight loss. One case report revealed disseminated KS on autopsy in a patient without cutaneous manifestations, but with lesions present on the stomach, small intestine, liver, spleen and mesentery. Yet another case report cited KS as the etiology for small bowel intussusception in a patient with undiagnosed HIV. Histology is characterized by expression of CD 34, CD 31, and D2-40 on immunohistochemistry as was seen with our patient. The association between cutaneous manifestation of KS and gastrointestinal manifestation remains unclear; however, the case serves as an important reminder to maintain a broad differential in the immunocompromised patient with weight loss.
Figure: Figure 1
Disclosures: Irma Hashmi indicated no relevant financial relationships. Nikita Chadha indicated no relevant financial relationships. Joseph Spataro indicated no relevant financial relationships.
Irma Hashmi, DO1, Nikita Chadha, DO2, Joseph Spataro, MD1. P0179 - Capturing the Audience: A Case of Kaposi’s Sarcoma in the GI Tract, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.