Acquired immunodeficiency syndrome related Kaposi sarcoma of the rectum in the absence of cutaneous manifestation

Abstract

Introduction: In developed countries, the incidence of Kaposi sarcoma (KS) has declined substantially with more widespread use of antiretroviral therapy (ART). The initial presentation of KS is usually cutaneous lesions. Uncommonly, KS is discovered in visceral organs without skin involvement. Isolated KS of the rectum is rare. Case Report: A 41-year-old man with history of iron deficiency anemia and external hemorrhoids presented with worsening rectal bleeding over three years with associated tenesmus and weight loss. On exam, no skin lesions were identified. Hemoglobin was 5.4 g/dL. Rapid human immunodeficiency virus (HIV) screen was positive. Absolute CD4 count was 37/uL. HIV-1 viral load was 328,790 copies/mL. Computed tomography (CT) scan revealed an irregular, circumferential 7 cm rectal mass with associated rectal and pelvic lymphadenopathy. Colonoscopy revealed a non-obstructing, circumferential, friable, ulcerated, nodular mass from the dentate line to 14 cm. Biopsy revealed ulcerated tissue and spindle cell proliferation with HHV-8 positive endothelial cells. Conclusion: We describe the case of a 41-year-old man with newly diagnosed HIV/AIDS and latent syphilis who presented with rectal bleeding and was found to have KS of the rectum with no prior history of skin lesion nor any evidence of cutaneous disease seen on thorough physical examination. Although uncommon, KS can present on visceral surfaces, such as the gastrointestinal (GI) tract, in the absence of cutaneous lesions. Isolated anorectal KS in the absence of skin involvement is rarely seen. Despite an endoscopic appearance which mimics adenocarcinoma, rectal KS should remain in the differential for rectal mass in an immunosuppressed patient, even without typical cutaneous lesions.