Endoscopic Appearance of Oropharyngeal and Upper GI Kaposi’s Sarcoma in an Immunocompromised Patient

Abstract

Introduction. Kaposi's sarcoma (KS) usually manifests as a cutaneous disease but GI manifestation is often rare. It is associated with human herpes virus-8 (HHV-8) and seen in immunocompromised patients. In the USA, use of highly active antiretroviral therapy (HAART) has drastically reduced incidence of KS in HIV patients. Case Presentation. A 65-year-old male with human immunodeficiency virus (HIV) was admitted to the intensive care unit (ICU) with cardiopulmonary arrest secondary to hyperkalemia of 7.5 meq/L. Following placement of orogastric and endotracheal tube (ETT), a significant amount of blood was noticed in the ETT. Hemoglobin trended down from 9.6 mg/dL to 6.7 mg/dL over five days. Stool guaiac was positive. Esophagogastroduodenoscopy (EGD) was performed and revealed multiple large hypervascularized violaceous submucosal nodular lesions with stigmata of bleeding seen on the soft palate and pharynx and within the cricopharyngeal area close to the vocal cords. Biopsy of the soft palate lesions showed proliferation of neoplastic spindle shaped cells arranged in bundles with slit-like capillary spaces containing erythrocytes consistent with Kaposi's sarcoma. Biopsy was positive for HHV-8. Colonoscopy was unremarkable. There were no cutaneous manifestations of the disease. Conclusion. GI involvement of Kaposi's sarcoma must be considered in immunocompromised patients and can be confirmed by endoscopic methods.

Gastrointestinal Kaposi Sarcoma without Dermatological Lesions: A Case Report

“…In the last 10 years, only 3 case reports have described patients with gastrointestinal lesions in the absence of cutaneous manifestations, as in our patient [ 6 , 9 , 10 ]. One case report by Daar et al in 2017 showed a similar presentation in a 65-year-old man with upper gastrointestinal lesions in the absence of cutaneous lesions, following a sharp drop in the hemoglobin level and findings of stool occult blood on admission.…”

“…AIDS-Kaposi sarcoma presenting exclusively with gastrointestinal lesions is seldom described in the literature. It is reported that 90% of Kaposi sarcoma presentations involve cutaneous lesions [ 6 ], with dark, violaceous plaques and nodules on the epidermis and mucosa. Few case reports have shown Kaposi sarcoma lesions in the setting of gastrointestinal bleeding; however, in most of these case reports, gastrointestinal lesions were also accompanied by dark violaceous cutaneous lesions on the face, trunk, or extremities [ 7 , 8 ].…”

“…AIDS-associated Kaposi sarcoma has no preferred location, it is widely scattered, and involvement of the lymph nodes and intestine usually occurs early [ 6 ]. Visceral involvement of Kaposi sarcoma without cutaneous lesions is rare in patients with AIDS/HIV.…”

Upper and Lower Gastrointestinal Endoscopic Findings in HIV-Infected Patients in the Era of Highly Active Antiretroviral Therapy

“…Kaposi's sarcoma is rarely found in the esophagus, and presents as dysphagia rather than odynophagia [ 5 ]. It appears as submucosal ulcerations or as linitis plastica in the stomach [ 6 ]. While Kaposi’s sarcoma lesions in the latter parts of the upper GI tract are generally asymptomatic, it has been reported to cause acute hemorrhage [ 6 , 7 ].…”

“…It appears as submucosal ulcerations or as linitis plastica in the stomach [ 6 ]. While Kaposi’s sarcoma lesions in the latter parts of the upper GI tract are generally asymptomatic, it has been reported to cause acute hemorrhage [ 6 , 7 ]. Our study did not document any cases of CMV/HSV infection or cases of Kaposi’s sarcoma or lymphoma, likely due to a relatively small sample size and higher CD4 count than that is usually found in patients with these disease entities.…”