University of Oklahoma Health Sciences Center Oklahoma City, OK
Taha Khan, MD1, Tokunbo Ajayi, MD2, Grace Braimoh, MD1, Donald Kastens, MD1 1University of Oklahoma Health Sciences Center, Oklahoma City, OK; 2University of Oklahoma Health Sciences Center, Oklahoma city, OK
Introduction: Kaposi Sarcoma is a malignant, highly vascularized tumor of endothelial cells caused by HHV8. Most commonly affects the skin but may also involve the GI tract and lymph nodes. Visceral involvement determines treatment options. We present a case of AIDS associated KS in a young male presenting with predominantly GI symptoms.
Case Description/Methods: 26-year-old male with a PMH significant for recently diagnosed HIV/AIDS and Cutaneous Kaposi Sarcoma presenting to the ED with 4 days of worsening fevers, nausea, vomiting, diffuse myalgia and multiple episodes of bloody diarrhea described as bright red blood mixed with brown liquid stool.
CD4 count on diagnosis was 176/mm3 and viral load was 1.83 million copies/mL, he was started on Biktarvy and Bactrim by ID. GI was consulted to evaluate etiology of GI bleed or alternate cause of colitis. Pertinent labs on admission include Hb 9.6 g/dL, Plt 53k/microL, Cr 1.5 mg/dL, HHV Quant 821k, Negative GI biofire and Cdiff testing. Full body PET CT revealed diffuse adenopathy and splenomegaly. Patient was scheduled for an inpatient EGD/Colonoscopy for further evaluation and results are demonstrated in attached images.
We confirmed KS with HHV 8 + on endoscopic biopsy of GI lesions. Lymph Node Biopsy was Negative for malignancy and positive for HHV 8. Patient is following with Hematology/Oncology and has received 3 cycles of Doxorubicin with significant improvement in GI symptoms. He is scheduled for a repeat EGD/Colonoscopy to evaluate for remission.
Discussion: AIDS-related Kaposi Sarcoma (KS), caused by HHV8, classically affects the skin, however GI involvement can also be seen and is linked with a poor prognosis. Lower CD4 counts < 500/mm3 in AIDS patients increase KS risk. It is often asymptomatic but can present with weight loss, abdominal pain, Nausea/Vomiting, GI bleeding, malabsorption, diarrhea and rarely intestinal obstruction or perforation.
Consider endoscopy for patients with predictive risk factors such as active GI symptoms, CD4 < 100 cells/uL, extensive oral/cutaneous lesions, HIV RNA ≥10,000 copies/mL, and no HAART history. Early detection improves outcomes with timely initiation of therapy.
Cutaneous KS is managed with ART and intralesional chemotherapy (vinblastine), while GI KS warrants ART and systemic chemotherapy (liposomal anthracyclines or Paclitaxel). Response rates are similar for cutaneous and GI KS, with better outcomes in less extensive cases and duodenal involvement, offering symptom relief even if lesions persist.
Figure: Fig. 1- Cutaneous KS lesions Fig. 2- Multiple small violaceous submucosal nodules in the rectum Fig. 3- Multiple small violaceous submucosal nodules in the sigmoid Fig. 4- Hemorrhagic submucosal nodule in rectosigmoid
Disclosures:
Taha Khan indicated no relevant financial relationships.
Tokunbo Ajayi indicated no relevant financial relationships.
Grace Braimoh indicated no relevant financial relationships.
Donald Kastens indicated no relevant financial relationships.
Taha Khan, MD1, Tokunbo Ajayi, MD2, Grace Braimoh, MD1, Donald Kastens, MD1. P2070 - Beyond The Surface: A Case Report on GI Manifestations of AIDS Related Kaposi Sarcoma, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
