A Rare Case Report of Hepatic Kaposi Sarcoma

Abstract

Kaposi sarcoma (KS) is the most frequent opportunist neoplasm found in AIDS patients. Hepatic involvement is rarely diagnosed at life. We report a case of biopsy proven hepatic KS in a patient with AIDS. A 34-year-old African American male with past medical history of HIV, not on HAART therapy for last 2 years and with no prior history of liver disease who presented with complaints of fatigue, fever, night sweats and sorethroat. On physical examination he had multiple hyperpigmented skin lesions in the temporal and maxillary regions, oral thrush and hepatomegaly. His Alkaline phosphatase 328 mu/ml, ALT 26 mu/ml, AST 50 mu/ml, Total bilirubin 1.9 mg/dl, platelets 62X10E9 and INR 1.23. His CD4 count was found to be 14 cells/μL. Abdominal ultrasound showed heterogeneous liver and CT abdomen showed characteristic multiple hypo dense lesions that were suggestive of hepatic KS. The patient underwent skin and liver biopsy which confirmed the diagnosis of KS. Liver biopsy showed portal areas that were expanded by an atypical spindle cell proliferation forming slit-like spaces and cells were positive for HHV-8. The patient was started on antiretroviral therapy and initiation of chemotherapy. AIDS-related Kaposi sarcoma is most often multicentric, extensive and aggressive. While KS can be seen at any stage of HIV infection, advanced disease with multifocal involvement usually occurs with a CD4 count < 200 cells/ μL. Hepatic involvement is unusual and asymptomatic. Ultrasonography shows echogenic infiltration and heterogeneous parenchyma with small hyperechoic nodules. CT shows hypodense lesions. In a patient with cutaneous or digestive Kaposi sarcoma lesions, these radiological aspects are suggestive of hepatic involvement. However, a definitive diagnosis of KS requires biopsy and histological examination. Treatment with chemotherapy is usually indicated because of the rapid progression of the tumor, although no prolongation of survival has been demonstrated. Hepatic KS is rarely reported in living patients. Autopsies show liver involvement in 35% of patients with KS. When characteristic radiological findings are encountered in an HIV-positive patient liver biopsy should be performed to clinch the diagnosis.Figure 1Figure 2