Hamad Ahmad, MD1, Hoore Jannat, MD2, Urooj Khan, MD3, Noaman Ahmad, MD4 1Westchester Medical Center, White Plains, NY; 2Khyber Medical College, White Plains, NY; 3Khyber Medical University, Huntsville, AL; 4Huntsville Hospital, Huntsville, AL
Introduction: Kaposi sarcoma, a vascular tumor associated with Human herpesvirus 8 (HHV-8), rarely presents with lower gastrointestinal bleeding. In such cases, the tumor typically involves the gastrointestinal mucosa, leading to ulceration and subsequent bleeding. Patients may experience symptoms such as abdominal pain, rectal bleeding, and the passage of bloody stools. The diagnosis of Kaposi sarcoma as the cause of lower gastrointestinal bleeding requires a high index of suspicion, particularly in individuals with a history of Human immunodeficiency virus (HIV) infection, AIDS or immunosuppression.
Case Description/Methods: A 45-year-old man with a medical history of untreated HIV leading to AIDS, syphilis, and anal wart removal in 2005 presented with recurring abdominal and rectal pain accompanied by bleeding. Additionally, he reported a palpable mass protruding through his rectum when wiping. Patient’s laboratory results were significant for low hemoglobin (9.3), low white cell count (4.13), and low CD4 count (145), positive HIV viral load, positive urinary and rectal swab Chlamydia trachomatis nucleic acid amplification test (NAAT). Colonoscopy showed large violaceous sessile lesions primarily in the rectum, extending to the anal canal and perianal skin, consistent with Kaposi sarcoma. A perianal biopsy showed neoplastic cells expressing CD31, HHV-8, Dog-1, CD34, and D2-40, confirming the diagnosis of Kaposi sarcoma. The patient was subsequently initiated on antiretroviral therapy (ART) for HIV/AIDS treatment, and Doxycycline for Chlamydia trachomatis urethritis/proctitis. The patient followed up as an outpatient and started on Doxorubicin for Kaposi sarcoma, as he continued to have intermittent rectal bleeding and did not show a response to ART alone.
Discussion: This case demonstrates that the varied clinical manifestations of Kaposi sarcoma, such as recurrent abdominal pain and rectal bleeding highlight the need to consider this malignancy in HIV/AIDS patients presenting with gastrointestinal symptoms. The patient received a multimodal treatment approach involving ART for HIV/AIDS, concomitant sexually transmitted infections (STIs), prophylaxis for opportunistic infections, and targeted therapy for Kaposi sarcoma. Such patients need close follow-up to allow for monitoring of therapy, adverse effects of therapy and initiation of additional treatment when needed.
Figure: Colonoscopy: Several scattered 1-2 cm and a large violaceous sessile lesion primarily in the rectum, extending to the anal canal and perianal skin; H&E Stain Perianal Skin Biopsy: Spindle cells in the dermis layer consistent with Kaposi Sarcoma
Disclosures:
Hamad Ahmad indicated no relevant financial relationships.
Hoore Jannat indicated no relevant financial relationships.
Urooj Khan indicated no relevant financial relationships.
Noaman Ahmad indicated no relevant financial relationships.
Hamad Ahmad, MD1, Hoore Jannat, MD2, Urooj Khan, MD3, Noaman Ahmad, MD4. P3499 - Kaposi Sarcoma in an Acquired Immunodeficiency Syndrome Patient With Recurring Abdominal Pain and Rectal Bleed, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.