Case of 54-year-old diagnosed with gastrointestinal Kaposi’s sarcoma
A 54-year-old man with no known medical history presented to the emergency with a 10-day history of bloody diarrhoea and a 3-month history of progressing red skin lesions. Other symptoms included cachexia, erythematous papules on the face, thorax, and legs. Edoema in the legs and feet, purplish nodules in the posterior oropharynx, and an enlarged abdomen were all discovered during the physical examination. Laboratory findings showed a positive HIV test, a CD4 count of 45 cells per cubic millimetre (reference range, 300 to 1400), and a viral load of 5.5 million copies per millimetre. Doctors diagnosed the patient with gastrointestinal Kaposi’s sarcoma.
An entire body computed CT revealed ascites, diffuse lymphadenopathy, a pleural effusion on the right side, pericardial effusion, diffuse intestinal wall thickening, and ascites. Both a colonoscopy and an upper endoscopy were done. The whole digestive tract, from the oesophagus to the rectum (Panel A, duodenum; Panel B, sigmoid colon), was covered in erythematous, polypoid lesions. Findings of the biopsy of the multiple lesions was consistent with the characteristics of Kaposi’s sarcoma. Based on these findings, doctors diagnosed the patient with Kaposi’s sarcoma with cutaneous and gastrointestinal involvement. The patient was also diagnosed with pneumonia linked to coronavirus which he contracted during his hospital stay. The patient passed away on the 32nd day after admission.
Kaposi’s sarcoma of the gastrointestinal tract
Kaposi’s sarcoma is a low-grade vascular tumour that is associated with the HHV-8 infection. The first time this tumour was documented was in 1872 by Dr. Moritz Kaposi, a dermatologist from Hungary, who wrote about 5 cases of “idio-pathic multiple pigmented sarcomas of the skin.” Kaposi’s sarcoma has 4 different types. All of them have been found to be associated with HHV-8, hence these forms most likely represent various symptoms of the same pathologic process.
Elderly men from Eastern Europe and the Mediterranean region are more likely to be infected with the classic type of Kaposi sarcoma. Although this variant is not connected to HIV, it does occur in association with immune system changes and malignant diseases. This variety can be identified clinically by numerous reddish-purple nodules on the lower extremities. These nodules gradually enlarge and are subsequently discovered in more proximal areas. The malignancies rarely develop systemically and are typically asymptomatic. The second variation is the endemic or African form of Kaposi sarcoma, which is associated with lymphadenopathy. This aggressive type is frequently encountered in young Bantu children in South Africa with localised or systemic lymphadenopathy.
Skin lesions are uncommon in gastrointestinal Kaposi’s sarcoma
In this type, skin lesions are uncommon. The third variation is the Kaposi sarcoma associated with immunosuppression or transplantation. This variant of Kaposi’s sarcoma appears between a few months and a few years following immunosuppressive organ transplantation. Although lesions usually start as skin lesions, they can also be discovered in lymph nodes and internal organs in about 50% of cases. The AIDS-associated (epidemic) form of Kaposi sarcoma is the fourth variation of the disease. The most prevalent AIDS-related tumour in the United States, this type is present in about one-fourth of all AIDS patients. Compared to nonhomosexual AIDS patients with the same level of immunodeficiency, homosexual males with AIDS experience kaposi sarcoma 20 times more commonly. Although there is no preferred location of AIDS-associated Kaposi’s sarcoma, it is often widely scattered. Similarly, the lymph nodes and intestines are involved relatively early.
Conclusion
Kaposi sarcoma is the most prevalent gastrointestinal cancer in AIDS patients. However, it is frequently asymptomatic and affects 40% of individuals. In AIDS individuals with cutaneous Kaposi sarcoma, there is a greater than 50% incidence of gastrointestinal Kaposi sarcoma. In this case, the patient was positive for AIDS.
While gastrointestinal Kaposi sarcoma is often asymptomatic, it has been associated with haemorrhages from the oral cavity, oesophagus, stomach, and large bowel. Some people report experiencing diarrhoea, nausea, vomiting, malabsorption, or stomach pain. Bowel perforation or obstruction are also possible side effects of gastrointestinal Kaposi sarcoma.
Source: NEJM
