Gastrointestinal Kaposi Sarcoma: An Underdiagnosed Entity

Barakat Altamimi; Rahman Nakshabendi; Woodlyne Roquiz; Mohamad Mokadem

doi:10.14309/00000434-201810001-02693

Kaposi's sarcoma is an angioproliferative disorder that is caused by HHV-8 infection. It is a common neoplasm among HIV-infected patients and can affect different organ systems. Gastrointestinal Kaposi Sarcoma is an underdiagnosed entity. 43 year old homosexual man was newly diagnosed with HIV/AIDs after being admitted to the ICU with respiratory failure secondary to pleural effusion and pulmonary infiltrates. Given these finding, pulmonary involvement with Kaposi sarcoma was suspected after all infectious workup came back negative. Bronchoalveolar lavage was positive for HHV-8. During the hospitalization he was noted to have several skin lesions and two oropharyngeal lesions classical of Kaposi sarcoma. The patient was started on HAART therapy and as outpatient received two cycles of paclitaxel with improvement in his scans and resolution of cutaneous lesions. Patient was noted on routine clinical workup to have anemia after his second dose of chemotherapy. His labs did not show hemolysis and his retic count indicated an acceptable marrow response. He reported having dark stools but otherwise was asymptomatic. Patient had EGD done which showed large fleshy mass over the lesser curvature about 3x3cm as well as another lesion over the antrum both of which were not actively bleeding. Biopsies taken from the lesion were consistent with Kaposi sarcoma. Gastrointestinal Kaposi sarcoma is underdiagnosed in the HIV population given that it is usually asymptomatic. Patients might present with abdominal pain, SOB or dizziness secondary to anemia and in rare cases with frank hemorrhage. Systemic Kaposi sarcoma is usually treated with HAART therapy and with pegylated liposomal doxorubicinhttps://www. uptodate.com/contents/pegylated-liposomal- doxorubicindruginfor mation? source=see_link> or liposomal daunorubicinhttps://www.uptodate.com/contents/liposomal-daunorubicin-drug-information?source=see_link>. Paclitaxel can be used as first line therapy in systemic Kaposi sarcoma. Physicians need to have a high level of suspicion, especially among HIV patients as most cases of gastrointestinal Kaposi sarcoma are asymptomatic and hence underdiagnosed. There are studies that suggest using certain clinical factors such as low CD4 cell count <100 cell/ ul, MSM and presence of cutaneous Kaposi to predict gastrointestinal involvement.Further studies are needed to assess rates of undiagnosed gastrointestinal kaposi sarcoma and need for screening EGDs.

Gastrointestinal Kaposi Sarcoma: An Underdiagnosed Entity

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