Kaposi's disease; report of an unusual case.

Abstract

Kaposi, in 1875, first described the disease that bears his name, now more properly known as “idiopathic multiple hemorrhagic sarcoma.” About 700 cases have been reported. Kaposi's disease is best known for its cutaneous manifestations, varying from soft vascular to firm pigmented nodules or plaques. These usually occur in the lower extremities; it is generally accepted that they are tumors of low-grade malignancy. Visceral involvement occurs in approximately 10 per cent of the cases, usually late in the course. The gastrointestinal tract is most fre-quently involved, but lesions have been described in practically every organ of the body. In recent years, Choisser and Ramsey (1), Aegerter and Peale (2), Tedeschi et al. (3), Weller (4), Nesbitt et al. (5), and others have reported cases in which visceral involvement occurred without evidence of skin lesions. In the case to be presented here, gastric lesions overshadowed the minor skin involvement, which was not even noticed on early examinations. Case Report F. S., a 53-year-old Negro male, was admitted in December 1953 with swelling of the legs and thighs of one year duration. He had previously been well. The swelling was first noticed on the right ankle, and later on the right knee. There was no associated dyspnea or orthopnea. About one month prior to admission, the patient had several episodes of either hemoptysis or hematemesis, producing on one occasion a “cupful” of bright red blood. Since then he had experienced marked exertional dyspnea. The edema gradually extended to both thighs. There was no abdominal pain, constipation, change in bowel habit, or loss of weight. The patient appeared well developed and well nourished, with marked pallor of the mucous membranes, but in no acute distress. The bloodpr essure was 130/70, pulse 120, respirations 20. Positive findings included a firm, fixed, non-tender mass at the angle of the right mandible and bilateral axillary and inguinal lymphadenopathy; the nodes were discrete and non-tender. A Grade II systolic murmur was heard at the base. There was moderate pitting edema of the left leg; the left thigh was swollen, but did not pit. Slight pitting edema of the right leg was present. The liver and spleen were not palpable. Admission laboratory findings included a marked anemia with a hemoglobin of 5 gm., 17,000,000 red cells, and hematocrit of 20. The non-protein nitrogen was 25 mg. per cent. Urinalysis was negative. Barium examination of the upper gastrointestinal tract revealed numerous small, smoothly rounded masses from the antrum to the fundus, projecting into the lumen of the stomach, suggesting a diffuse gastric polyposis (Figs. 1 and 2). Peristalsis was normal and the walls of the stomach were pliable. Several transfusions were given. After these, the platelet count was found to be 30,000. Bleeding and clotting time were normal.