S3016 Diffuse Mucosal Kaposi Sarcoma: An Unusual Cause of Abdominal Pain

Abstract

INTRODUCTION: Kaposi Sarcoma (KS) is a rare angioproliferative disease accounting for approximately 0.001% of all malignancies diagnosed in the USA. KS commonly presents as cutaneous disease associated with AIDS and human herpes virus-8 infection. We present a case of mucosal KS in a patient presenting with recurrent abdominal pain. CASE DESCRIPTION/METHODS: A 33-year-old male with a past medical history of HIV on HAART (CD4 count of 50 and undetectable viral load) presented to the ED with intermittent generalized abdominal pain and dyspepsia. He’d presented to the emergency department with this complaint several times over the past two years but always declined further workup. However, he’d now become progressively dyspneic with minimal exertion. He denied any other symptoms. He was tachycardic to 110 but otherwise hemodynamically stable. He was in no distress. Multiple plaque-like, skin lesions were noted on his face, chest and right lower extremity. His oral mucosa had multiple lesions. No oral thrush or oropharyngeal crowding was noted. Labs revealed a hemoglobin of 7, AST of 368U/L, ALT of 108U/L, ALP of 236U/L. FOBT was positive. CXR revealed his stomach was dilated with multiple nodular densities. CT chest and abdomen confirmed multiple soft tissue nodules in the lumen of the stomach in addition to many nodular opacities throughout the lungs. On esophagogastroduodenoscopy multiple nonbleeding lesions extending from the oropharynx to the pylorus were seen. The lesions ranged in size and appearance from flat, maculopapular lesions to polypoid masses. These finding were, highly suggestive of mucosal KS. The patient was continued on HAART and liposomal doxorubicin was initiated. The patient was discharged with plans for outpatient follow up. DISCUSSION: Mucosal KS lesions are highly variable and have the potential to cause anemia, obstruction and even life-threatening hemorrhage. Treatment includes HAART and initiation of chemotherapy, immunotherapy or biologic agents. Rarely, surgery may be indicated.Given its rarity, diagnosis of mucosal KS requires a high index of suspicion. Further studies are needed to help clinicians determine when to initiate screening EGDs. Due to lack of screening guidelines, we urge consideration of mucosal KS when treating patients infected with AIDS.