Kaposiʼs Sarcoma

Abstract

A 56 y/o HIV-infected African American male presented with non-bloody diarrhea for 3 days. He also complained of diffuse abdominal pain, worse in the epigastric area, for the past 4 months and associated with nausea and intermittent non-bloody, non-bilious vomiting, especially after eating solid food. He admits to 33 pounds weight loss over 6 months. He denies any fever or chills, any rash or skin lesions. His HIV risk factor was intravenous drug use. His CD4 count was 46 cells/mm3 and HIV RNA was 123,664/ml. He was non-compliant with HAART. Co-morbid conditions included polysubstance abuse and HCV infection. There was moderate epigastric tenderness on physical examination. Laboratory studies showed anemia, stool studies were negative for enteric pathogens, but stool occult blood was positive. A CT scan of abdomen with contrast showed prominent lymph nodes in the paraesophageal and retroperitoneal areas. An EGD showed a large, fungating, circumferential mass with no bleeding in the gastric antrum. Biopsies were performed and the pathologic diagnosis was Kaposi's sarcoma (KS). Immunohistochemical stains for HHV-8 were positive.Figure: [648]Conclusion: In the pre-HAART era, the prevalence of KS was over 20,000 times higher in patients with AIDS than in the general population. The use of HAART has led to a decline in the prevalence of AIDS-related KS, but the benefit is limited to patients who adhere to therapy. Skin involvement is characteristic but extracutaneous spread is common, particularly to the oral cavity, GI tract, and respiratory tract. Before the HAART era, GI tract involvement was 40% and occurred without cutaneous disease in many cases. Patient may be asymptomatic or can have weight loss, nausea, vomiting, abdominal pain, malabsorption, GI hemorrhage, intestinal obstruction, or diarrhea. The visual lesions are characteristic and the diagnosis can be confirmed on histopathology. The staging system, developed by AIDS Clinical Trials Group (ACTG) of the National Institute of Health, which consists of 3 parameters: extent of tumor, Immune status and severity of systemic illness, divides patients into good and poor risk categories. Treatment depends on the presence or absence of clinical symptoms as well as on CD4 count, HIV viral load and presence of HHV-8. For symptomatic patients, the treatment is chemotherapy with liposomal anthracyclines as well as antiretroviral therapy to optimize cellular immune function.