HIV Associated Kaposi’s Sarcoma with Visceral Involvement and Rectal Bleeding

Abstract

Abstract Introduction/Objective Kaposi’s sarcoma (KS) is one of the complications of advanced HIV disease and human herpes virus 8 (HHV-8) is the etiological agent. Most cases of KS are cutaneous and resolved with HIV treatment, few cases of KS present with visceral involvement and have a poor prognosis. Any part of the gastrointestinal tract (GIT) may be affected by KS, however visceral involvement without cutaneous lesions is extremely rare. KS has metastatic potential and can be fatal if treatment is not initiated immediately. Methods/Case Report A 29 years old homosexual man with a history of multiple sexually transmitted diseases and HIV infection (CD4: 331 cell/μL, CD4/CD8: 0.2, HIV RNA: 10542 copies/mL) presented to the emergency department in a hypovolemic state with hemoglobin of 6 g/dl. He received HAART 3 years ago but discontinued it due to the COVID pandemic. He had a history of recurrent and intermittent rectal bleeding which was exacerbated during the past 3 months. On physical examination, a bleeding rectal mass and bilateral inguinal adenopathy were noted. An imaging study was performed and showed a 14 cm anorectal mass extruding through the anal canal, with bilateral axillary, inguinal, pelvic side walls, iliac chains, and periaortic lymphadenopathy. Flow cytometry of the fresh biopsy tissue revealed a T cell-predominant lymphoid population with reversed CD4/CD8 ratio, compatible with the patient's known history of HIV, with no immunophenotypic evidence of lymphoma. Histopathologic examination of an excisional biopsy of the rectal mass showed mild to moderate atypical spindle cells arranged in vague fascicles and separated by slit-like vessels and extravasated red blood cells. Immunohistochemical (IHC) stain revealed the atypical spindle cells were positive for HHV-8, CD31, CD34, D2-40, BCL2, Vimentin, and Ki-67 (35%-highly proliferative) whereas these cells were negative for AE1/AE3, CK5/6, P40, CD45, Desmin, and S100. A diagnosis of KS was made. Results (if a Case Study enter NA) NA Conclusion We present a case of visceral KS without cutaneous involvement, which may pose a difficulty in diagnosis. The GIT, lungs, and lymph nodes are the relatively common sites that are affected by visceral KS. KS manifests various histopathological and clinical pictures, and a delay in diagnosis can cause a worse prognosis. The treatment options for KS are depending on the clinical presentation and the extension of the lesions. A combination of HAART, chemotherapy, and radiotherapy could be an effective treatment in the early stage of the disease.