Kaposi's sarcoma: An opportunistic infection by human herpesvirus-8 in ulcerative colitis

Abstract

Kaposi's sarcoma is a vascular tumor caused by human herpesvirus-8 infection. Iatrogenic Kaposi's sarcoma often occurs in patients receiving immunosuppressive therapy. To date, a few cases of colonic Kaposi's sarcoma have been reported in ulcerative colitis patients treated with immunomodulators. We describe a 65-year-old male diagnosed with left-sided ulcerative colitis who was treated with methotrexate and low-dose steroids for greater than 6 years. He presented with several papular, violet lesions on both legs. Colonoscopy revealed the presence of multiple reddish, elevated lesions in the sigmoid colon and rectum. Histological evaluation of skin and colonic biopsies showed findings suggestive of Kaposi's sarcoma; immunohistochemistry for human herpesvirus-8 was positive in the colonic lesions. To avoid the need for further immunosuppressive treatment, the patient underwent a colectomy. Following immunomodulator discontinuation, the patient experienced spontaneous regression of his skin lesions. With the present case, we wish to stress the important interaction of immunosuppressive therapy (mainly corticosteroids) used in ulcerative colitis patients in relation to the development of colonic Kaposi's sarcoma. Human herpesvirus-8 infection should be recognized as a possible opportunistic infection in patients with inflammatory bowel disease.

Chronic intestinal inflammation in mice expressing viral Flip in epithelial cells

“…Moreover under pathogenic conditions there might be a direct connection between HHV8 infection and gut inflammation, since several case reports showed IBD patients suffering from HHV8-induced diseases. [66][67][68][69][70] While our study was not intended to provide evidence for a role of HHV8 in IBD, we for the first time show, that expression of a single protein from a Human herpesvirus is able to disrupt intestinal homeostasis and to drive chronic inflammation in the gut.…”

Clinical and Endoscopic Features of Gastrointestinal Kaposi Sarcoma: A Single-Center Portuguese Experience over the Last Decade

“…Reports of colonic KS in ulcerative colitis are rare. In these patients, the diagnosis of colonic KS could be challenging, as in our patient, who presented with a pseudotumoral, nontypical appearance [15] . Therapeutic approach of immunosuppression-associated KS involving the colon is not well defined in the literature and, even though some of these patients have been treated with proctocolectomy [15] , the withdrawal of immunosuppression could be enough to induce remission, as was the case in our patient.…”

Human herpesvirus 8-associated colonic Kaposi’s sarcoma during vedolizumab treatment in ulcerative colitis: a case report and review of the literature

“…In most cases, iatrogenic KS appears in kidney-transplanted patients. However, it has also been reported in chronic inflammatory conditions that require immunosuppressive therapies for a long period such as UC [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] and CD [21][22][23][24]. In this scenario, the anti-TNF-α agents, the anti-integrin agent VDZ and, recently, the anti-interleukin (IL)-12/23 ustekinumab have been added to the IBD therapeutic armamentarium, which already included steroids and the traditional immunosuppressants (i.e., azathioprine, methotrexate, and cyclosporine).…”