1960 Life-Threatening Gastrointestinal Bleeding Secondary to Kaposi’s Sarcoma of the Duodenum

Abstract

INTRODUCTION: Kaposi’s sarcoma is common in patients with AIDS. Gastrointestinal involvement is not uncommon. However, a life-threatening bleeding is rare. CASE DESCRIPTION/METHODS: A 58-year-old bisexual male with a history of AIDS presented to the clinic with progressive dyspnea, dizziness and unintentional weight loss. He was found to be tachycardic and hypotensive. Physical exam revealed a non-tender, non-pruritic, dark purple skin lesions over his body, face and scalp. The patient was admitted for further evaluation. His initial labs revealed a Hb of 6.2 g/dl and a CD4 count of 120 cells/µL. CT scan of the abdomen and pelvis showed multiple enlarged lymph nodes in the peri aortic, right external iliac and porta-cava areas. He was initiated on HAART and a skin biopsy was performed. While inpatient, Hb dropped to 5.8 g/dl, which responded appropriately to 2 units of pRBCs. However, Hb dropped again and the patient started to have melena and hematochezia for which he was transferred to the ICU for close observation and resuscitation. A continuous infusion of pantoprazole 8 mg/hour was initiated. An EGD and colonoscopy were performed after resuscitation. The EGD showed erosive esophagitis, multiple non-bleeding gastric ulcers with a flat pigmented spot and non-bleeding duodenal erosions. The stomach and duodenum were biopsied. The colonoscopy showed old clotted blood in the entire examined colon. The patient underwent a second look EGD due to persistent melena and Hb drop which showed clotted blood in the gastric fundus, as well as a large, cratered gastric body ulcer, along the greater curve with adherent clot. Most of the clot was removed without bleeding or high-risk stigmata. Over the next few hours, the patient became hemodynamically unstable with increasing amounts melena. The interventional radiology team was consulted, and an urgent selective embolization was performed to the right gastroepiploic artery which was coursing through the ulcer. The patient stabilized and was eventually discharged with a plan of outpatient follow up. The biopsies from skin, stomach and duodenum showed proliferating spindle cells forming slit-like vascular channels within the lamina propria. HHV-8 immunostaining was positive. DISCUSSION: Involvement of the GI tract by Kaposi’s sarcoma is usually asymptomatic but hemorrhages, even though uncommon, have been reported. An adequate endoscopic sampling is crucial to avoid false negative results. However, severe bleeding may occur due to the hypervascularity of the lesion.