Lower Gastrointestinal Kaposi Sarcoma in HIV/AIDS: A Diagnostic Challenge

Abstract

Gastrointestinal Kaposi sarcoma (GI-KS) is the most common extra-cutaneous site of KS in HIV/AIDS, and the majority (75%) of affected patients are asymptomatic. GI-KS rarely occurs in the absence of cutaneous lesions. Opportunistic GI infections in HIV/AIDS and GI-KS can present with similar symptoms especially diarrhea, creating a diagnostic challenge. We present a 46-year-old homosexual male with a medical history of HIV/AIDS and neurosyphilis, who presented with 2 weeks of nonbloody diarrhea and abdominal discomfort. He was initially worked up for infectious diarrhea, initiated on highly active anti-retroviral (HAART) and supportively managed with rehydration therapy and analgesia. However, his clinical symptoms did not improve, necessitating abdomen/pelvic CT scan which revealed extensive recto-sigmoid colon thickening and pelvic lymphadenopathy. Due to a high suspicion of malignancy, diagnostic endoscopy and biopsy were done which showed colonic KS. He was treated with intravenous pegylated doxorubicin in addition to HAART which evidently resulted in significant clinical and radiological improvement. The diagnosis of GI-KS could be challenging in the presence of overlapping features with opportunistic GI infections and the absence of cutaneous manifestations of KS because clinicians tend to focus more on infectious etiology. We suggest that clinicians should consider GI-KS in the differential diagnosis of patients with HIV/AIDS that present with diarrhea and other nonspecific abdominal symptoms. Early endoscopic evaluation with biopsy could help to ensure the timely diagnosis and management of GI-KS and ultimately improve outcomes.

Imaging of Kaposi sarcoma

“…In gastric KS, particularly, one may see thickened folds, masses, and enhancing lymph nodes [41]. GI KS in the colon can be associated with abdominal cramps and diarrhea [42]. CT scans may show thickening of the colon and lymphadenopathy in the pelvis [42].…”

“…GI KS in the colon can be associated with abdominal cramps and diarrhea [42]. CT scans may show thickening of the colon and lymphadenopathy in the pelvis [42]. KS of the small bowel is uncommon and largely affects patients with HIV [43].…”

Sarcoma de Kaposi del tracto grastrointestinal. Reporte de caso.

“…En el SK, el tracto gastrointestinal es el sitio extracutáneo más comúnmente afectado, y las lesiones gastrointestinales pueden estar presentes incluso en ausencia de lesiones cutáneas (2). Puede presentarse en cualquier localización del tubo digestivo, aunque afecta predominantemente al tracto digestivo alto (principalmente al estómago), siendo la afectación colónica infrecuente (8)(9).…”

Diagnostic dilemma: a patient with diarrhoea

“…First described in 1872 by Kaposi, Kaposi Sarcoma is caused by HHV-8 and can be seen in a patient with or without HIV 1. While mostly manifesting as a cutaneous lesion, Kaposi sarcoma involving the gastrointestinal tract is the most common extracutaneous area of involvement in patients with HIV 1…”