Kaposi Sarcoma Mimicking Acute Flare of Ulcerative Colitis

Kumar, Varun; Soni, Parita; Garg, Mohit; Abduraimova, Madina; Harris, Jonathan

doi:10.1177/2324709617713510

Cited by 10 publications

(12 citation statements)

References 17 publications

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“…Several case reports have been published highlighting the association of KS and UC [15][16][17]. Like in our case, the patients were presented with bloody or watery diarrhea, abdominal pain and weight loss.…”

Section: Discussionmentioning

confidence: 77%

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A Case of Kaposi's Sarcoma of the Rectum in a Homosexual Male with HIV–AIDS

Katić¹,

Todorović²,

Nagorni³

et al. 2017

J Infect Dis Ther

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Kaposi sarcoma (KS) is a locally aggressive endothelial tumor, commonly diagnosed among individuals with acquired immunodeficiency syndrome (AIDS). The most typical site of involvement by KS is the skin, but in some cases, it can also affect other tissues and organs. Most patients with gastrointestinal involvement of Kaposi's sarcoma remain asymptomatic and they are often diagnosed on endoscopy or autopsy. However, there are cases of KS mimicking ulcerative colitis (UC), whereby clinical manifestations can confuse physicians. We report a 31 y old homosexual man who presented with rectal pain and bleeding. Patient was diagnosed eight years ago with HIV/ AIDS, and despite highly active retroviral therapy, he developed extensive skin lesions. Because of expressive rectal pain and bleeding, he underwent rectoscopy, which revealed ulcerous and hemorrhagic lesions. The rectoscopic and clinical presentation mimicked acute flare of UC, which was patient initial diagnosis. Tissue samples were collected for microscopical examination. After histological, histochemical and immunhistochemical examination of the sampled tissue, KS diagnosis was confirmed. The clinical manifestations of Kaposi sarcoma can be confused with acute exacerbation of ulcerative colitis often delaying the diagnosis. Therefore, early endoscopic evaluation with adequate biopsies could help in timely diagnosis and management of gastrointestinal KS (GI-KS) in patients with HIV/AIDS, even if they do not have skin lesions.

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Section: Discussionmentioning

confidence: 77%

“…However, there are cases of KS mimicking ulcerative colitis (UC), whereby clinical manifestations can confuse physicians [8,9]. Therefore, it could pose a serious diagnostic challenge.…”

Section: Introductionmentioning

confidence: 99%

A Case of Kaposi's Sarcoma of the Rectum in a Homosexual Male with HIV–AIDS

Katić¹,

Todorović²,

Nagorni³

et al. 2017

J Infect Dis Ther

View full text Add to dashboard Cite

show abstract

“…In most cases, iatrogenic KS appears in kidney-transplanted patients. However, it has also been reported in chronic inflammatory conditions that require immunosuppressive therapies for a long period such as UC [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] and CD [21][22][23][24]. In this scenario, the anti-TNF-α agents, the anti-integrin agent VDZ and, recently, the anti-interleukin (IL)-12/23 ustekinumab have been added to the IBD therapeutic armamentarium, which already included steroids and the traditional immunosuppressants (i.e., azathioprine, methotrexate, and cyclosporine).…”

Section: Discussionmentioning

confidence: 99%

Human herpesvirus 8-associated colonic Kaposi’s sarcoma during vedolizumab treatment in ulcerative colitis: a case report and review of the literature

et al. 2020

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Background: Kaposi's sarcoma (KS) is a rare vascular tumor associated with human herpesvirus (HHV)-8 infection.One of the variants of KS is defined iatrogenic and is overall reported in transplanted patient but also, although less frequently, in patients treated with long-standing immunosuppressive therapy, such as in inflammatory bowel disease including ulcerative colitis and Crohn's disease. Case presentation: Herein, we report the first case of KS in a human immunodeficiency virus (HIV)-negative 47year old male with UC after treatment with the α4-β7 integrin inhibitor vedolizumab (VDZ). The patient underwent to colectomy for a medical refractory disease and the histological examination of the surgical specimen showed the typical findings of KS together with the HHV-8 positivity. The patient achieved a good health status, without any sign of disease recurrence. Conclusions: In the present case, we can assume that VDZ may have promoted the reactivation of a latent HHV-8 infection endowed with oncogenic potentialities and, in turn, the onset of KS. We also briefly reviewed all the cases of KS in HIV-negative patients with inflammatory bowel disease.

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“…But, intestinal Kaposi’s sarcoma has also been reported during the last decades in HIV-negative patients treated with immunosuppressive drugs for ulcerative colitis or Crohn disease, mimicking acute flare of colitis. Table 1 summarizes the cases reported since 2000 [ 9 – 22 ], as well as the other cases diagnosed in HIV-negative patients treated with immunosuppressive drugs after organ transplantation or for another inflammatory disease. In our case, we observed the complete resolution of Kaposi’s sarcoma 2 months after rituximab discontinuation without the use of any specific treatment.…”

Section: Discussionmentioning

confidence: 99%

Reversible rituximab-induced rectal Kaposi’s sarcoma misdiagnosed as ulcerative colitis in a patient with HIV-negative follicular lymphoma

et al. 2018

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BackgroundKaposi’s sarcoma is a low-grade mesenchymal angioproliferative tumor, most commonly observed in immunocompromised individuals, such as HIV-infected patients. Iatrogenic Kaposi’s sarcoma occurs in patients undergoing immunosuppressive therapies. Rituximab is a chimeric monoclonal antibody targeted against the pan B cell marker CD20. Because of its immunosuppressive effects through reduction of mature B-cells, it may exacerbate Kaposi’s sarcoma in HIV-positive patients. Rituximab-related Kaposi’s sarcomas have been previously reported in only two HIV-negative patients and were treated surgically.Case presentationHere, we report on a Kaposi’s sarcoma that developed under rituximab treatment in a HIV-negative 55-year-old patient treated for follicular lymphoma. The lesion developed during the maintenance rituximab therapy at the rectal level with an aspect of apparent ulcerative colitis, without any cutaneous lesion. The premature stop of rituximab led to the complete regression of Kaposi’s sarcoma, without any additional specific treatment.ConclusionsTo our knowledge, this is the third case of Kaposi’s sarcoma diagnosed under rituximab in a HIV-negative patient, the first one at the rectal level and the first one that completely regresses after stop of rituximab. This case raises awareness of iatrogenic Kaposi’s sarcoma in HIV-negative patients treated with rituximab, and further highlights the importance of immunosuppression in the pathophysiology of disease.

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Kaposi Sarcoma Mimicking Acute Flare of Ulcerative Colitis

Cited by 10 publications

References 17 publications

A Case of Kaposi's Sarcoma of the Rectum in a Homosexual Male with HIV–AIDS

A Case of Kaposi's Sarcoma of the Rectum in a Homosexual Male with HIV–AIDS

Human herpesvirus 8-associated colonic Kaposi’s sarcoma during vedolizumab treatment in ulcerative colitis: a case report and review of the literature

Reversible rituximab-induced rectal Kaposi’s sarcoma misdiagnosed as ulcerative colitis in a patient with HIV-negative follicular lymphoma

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