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FIGURE 1: Brain MRI showing an extensive hyperintense lesion on T2 and FLAIR images in the left frontal parasagittal cortico-subcortical (A) and striatocapsular regions (B) and right frontal subcortical area (C).

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We present a case of a 53-year-old man, admitted in Emergency Department (ED) for a one-week history of dyspnea and non-productive cough. He had an history of Parkinson's disease and recent diagnosis of HIV-1 infection (subtype B) and syphilis. He reported unprotected heterosexual relationships with several partners. After evaluation at ED he was hospitalized due to new onset normochromic normocytic anemia (hemoglobin: 7.8 g/ dl), acute kidney injury (serum creatinine of 1.27 mg/dL and urea of 73 mg/dL) and respiratory failure, assuming probable opportunistic pulmonary infection. Upon admission, immunovirological staging was performed: CD4 + T cell count of 124/µL (21%), HIV-1 viral load of 368,000 copies/mL and HLA-B5701 negative. The diagnosis of pneumonia due to parainfluenza virus 1 and 3 was made and non-invasive ventilatory support was provide. During hospitalization he presented with multiple infectious complications. Introduction of ART with lamivudine, abacavir and dolutegravir was only possible after clinical stabilization and opportunistic infection were excluded. Meanwhile, the main active problem was persistent pancytopenia (with minimum hemoglobin values of 5.8 g/dL) requiring transfusion support. The laboratorial study was notable for ferropenia (29 mg/dL) and oligoclonal peak gamma protein electrophoresis, but with negative urine or serum immunofixation. There was no identification of lytic or blast lesion on the X-ray of the skull and axial skeleton. Abdominal-pelvic CT scan showed hepatosplenomegaly, ganglia without intra-abdominal pathological volumetric criteria. In bone biopsy, myelogram with moderate plasmacytosis and sterile myelculture were observed. These findings supported the diagnostic impression of a hyperreactive bone marrow in the context of HIV infection, rather than the hypothesis of lymphoproliferative disease. In the meantime he presented melena. An upper digestive endoscopy was performed showing compatible petechial le- ABSTRACTGastrointestinal bleeding related to Kaposi's Sarcoma is rare in AIDS patients; the etiology of anemia is usually multifactorial. We describe the case of a HIV infected, 53 year old patient with refractory anemia requiring frequent transfusion support. He was a patient with multiple complications and recent introduction of drugs that could justify myelosuppression and anemia. Due to inconclusive endoscopic examinations, the appearance of melena was the clue of the investigation, which concluded in the diagnosis of duodenal Kaposi's Sarcoma.

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