Intestinal Kaposi's Sarcoma Research Articles

Iatrogenic Kaposi sarcoma of the small bowel in Crohn’s disease following short-term use of immunomodulators: a case report and review of the literature

BackgroundKaposi sarcoma is a vascular tumor highly related to human herpesvirus-8 and Kaposi sarcoma–associated herpesvirus. Kaposi sarcoma usually manifests as skin or mucosal lesions; involvement in visceral organs such as the gastrointestinal tract is rare. Kaposi sarcoma can occur in immunocompromised patients receiving immunosuppressive therapy, in which case it is known as iatrogenic Kaposi sarcoma or drug-induced Kaposi sarcoma. Intestinal Kaposi sarcoma in patients with inflammatory bowel disease is extremely rare.Case presentationA 46-year-old East Asian male with recently diagnosed Crohn’s disease was administered azathioprine and prednisolone; however, the patient complained of persistent abdominal pain and diarrhea following treatment. Endoscopy revealed small bowel Kaposi sarcoma. The patient was treated with systemic chemotherapy successfully without relapse.ConclusionsThis is the fifth case of Kaposi sarcoma developed over the small intestine in a patient with Crohn’s disease following administration of immunomodulators. Additionally, this case indicated that even short-term immunomodulator use can induce Kaposi sarcoma in patients with inflammatory bowel disease. Thus, in patients with inflammatory bowel disease, if symptoms are aggravated or do not abate after immunomodulators prescription, and before intending to upgrade immunomodulators, endoscopy should be considered. Finally, chemotherapy can also be considered if both medication withdrawal and surgical intervention are not feasible.

Iatrogenic Kaposi Sarcoma in an HIV-Negative Young Man With Crohn Disease and IgA Nephropathy: A Case Report and Review of the Literature

Kaposi sarcoma (KS) is a vascular tumor associated with human herpesvirus 8 (HHV8) infections. The iatrogenic variant of KS frequently occurs in human immunodeficiency virus (HIV)-negative patients receiving prolonged immunosuppressive therapy. Isolated intestinal KS in the background of Crohn disease (CD) is exceeding rare, with only 2 reported cases in the literature since 1966. Here we report a case …

Small Bowel Kaposiʼs Sarcoma: An Unusual Cause of GI Bleeding

Purpose: A 34-year-old previously healthy man presented with 1 week of melena and new right sided hemiplegia for 1 month. Initial hemoglobin was 6 g/dL from a baseline of 13.5 g/dL two years prior. Brain MRI showed two ring enhancing lesions in the left cortex and cerebellum suspicious for toxoplasmosis. An HIV antibody test was positive, with a CD4 count of 1. An upper endoscopy was performed and showed white adherent material in the esophagus (biopsy pathology positive for candidiasis), gastric erythema and normal duodenum without a bleeding source. Colonoscopy showed normal terminal ileal and colonic mucosa. A capsule endoscopy demonstrated a raised medium-sized submucosal erythematous mass in the mid-jejunum, suspicious for Kaposi's sarcoma (KS). A detailed skin exam yielded a violaceous plaque on the abdomen, with biopsy pathology diagnostic of KS. The patient was started on antiretroviral therapy (ART) and treatment for cerebral toxoplasmosis, with no further episodes of melena. KS is a vascular tumor that is associated with human herpesvirus 8 and is the most common tumor arising in HIV-infected persons. Its prevalence is increased with lower CD4 counts. KS was over 20,000 times more common in persons with AIDS than in the general population prior to the widespread use of highly active antiretroviral therapy (HAART), and the incidence has declined substantially since that time. Although KS can involve virtually any site in the body, cutaneous disease is most common and is the usual initial presentation for KS. The most frequent sites of noncutaneous disease are the oral cavity, gastrointestinal tract (most commonly the small intestine) and respiratory system. Prior to widespread ART, the gastrointestinal tract was involved in approximately 40% of patients with KS at initial diagnosis, and in up to 80% at autopsy. However, visceral involvement as the initial manifestation of KS in the HAART era is relatively uncommon. GI lesions may be asymptomatic or cause weight loss, abdominal pain, nausea and vomiting, upper or lower gastrointestinal bleeding, malabsorption, intestinal obstruction or diarrhea. On endoscopy, KS lesions are easily recognized as hemorrhagic nodules that can appear anywhere along the GI tract. In the HAART era the incidence of AIDS-related KS has dramatically decreased to less than 10% of the incidence reported in the pre-HAART era, but it is still recognized as a primary AIDS-defining illness that can lead to significant morbidity. Rarely, visceral KS can present as occult or gross GI bleeding. In persons with underlying AIDS presenting with anemia and/or GI bleeding, it is important for physicians to consider intestinal KS as a possible etiology.

Gastrointestinal Kaposi′s sarcoma presenting as ileocolic intussusception

Context:Kaposi's sarcoma (KS) is the most common neoplasm in patients with acquired immune deficiency syndrome (AIDS). Gastrointestinal (GI) involvement with KS commonly occurs in association with cutaneous lesions or lymph node involvement, with GI tract involvement alone occurring in only 3.5% of cases. There are several case reports described in the literature about asymptomatic intestinal KS with skin manifestations. Although GI KS is usually asymptomatic, hemorrhages from the oral cavity, esophagus, stomach, and large bowel have been reported in this disease.Case Report:Our case is unique, in a way that the patient does not have skin manifestation, and also is that the first manifestation presented as acute intestinal intussusception and obstruction with nodular mass lesions of the stomach and GI tract due to GI KS.Conclusion:As a differential diagnosis of KS, nonHodgkin lymphomas frequently involve the gut in AIDS patients. Furthermore, tumors of the gut with spindle-shaped cells such as leiomyomas, rhabdomyosarcomas, high-grade pleomorphic sarcomas, or GI stromal tumors have to be considered in the differential diagnosis. Overall, the visceral involvement of the KS is usually associated with poor prognosis. Our case illustrates the importance of physicians to recognize GI KS as a differential diagnosis for HIV positive patients with recurrent abdominal pain. It is commonly occurs in association with cutaneous lesions or lymph node involvement and rarely presents with GI involvement alone, which is makes it a challenge to the physician.

KSHV/HHV8-Associated Intestinal Kaposi's Sarcoma in Patient with Ulcerative Colitis Receiving Immunosuppressive Drugs

Kaposi sarcoma-associated herpesvirus (KSHV), also known as human herpesvirus 8 (HHV8), has been identified in all four forms of Kaposi's sarcoma (classic, endemic, HIV-associated and iatrogenic). We report the rare case of an intestinal (small intestine and rectosigmoid) Kaposi's sarcoma in a 62-year-old HIV-negative man with ulcerative colitis. This patient was receiving immunosuppressive therapy with steroids and azathioprine. To date, the causative role of KSHV/HHV8 in the pathophysiology of Kaposi's sarcoma associated with ulcerative colitis has only been proven for cutaneous lesions but not for intestinal lesions of Kaposi's sarcoma. We report for the first time, the expression of HHV8 (by using immunohistochemistry) in colonic Kaposi's sarcoma in a patient with an ulcerative colitis-related tumor. The patient underwent a total proctocolectomy. At laparotomy, numerous Kaposi's sarcoma lesions were found in the small intestine, which were left in situ. Forty months after surgery and following withdrawal of immunosuppressive therapy, the patient had no evidence of any disease and a normal abdominal and thoracic CT scan. Cases of colorectal Kaposi's sarcoma complicating inflammatory bowel disease should be managed with a conservative approach and discontinuation of the immunosuppressive treatment. However, discontinuation of the immunosuppression is not always possible and in those cases chemotherapy may be indicated.

Intestinal Kaposi’s sarcoma may mimic gastrointestinal stromal tumor in HIV infection

Diffuse intestinal Kaposi's sarcoma shares macroscopic and histopathologic features with gastrointestinal stromal tumors. Correct diagnosis may pose a clinical challenge. We describe the case of a young HIV-1-infected African lady without advanced immunodeficiency, who presented with a diffuse spindle cell tumor of the gut. Initial diagnosis was of a gastrointestinal stromal tumor, based on endoscopy and histopathology. Further evaluation revealed evidence for human herpesvirus 8 (HHV8) and the diagnosis had to be changed to diffuse intestinal Kaposi's sarcoma. Antiretroviral triple therapy together with chemotherapy was commenced, and has led to the rapid remission of intestinal lesions. With a background of HIV infection, the presence of HHV8 as the causative agent of Kaposi's sarcoma should be determined, as distinct treatment is indicated.

Etiology and outcome of lower gastrointestinal bleeding in patients with AIDS

Objective: The objective of the study was to investigate bleeding (LGIB) in patients with acquired immunodeficiency syndrome (AIDS). Methods: All hospitalized AIDS patients with LGIB evaluated by the gastroenterology service at a large city-county hospital during a 6 yr period were identified by database review and by endoscopy and consultation records. Results: Of the 691 AIDS patients seen during the study period, 18 (2.6%) (median age 41 ± 7 years) were evaluated for LGIB. In these patients, LGIB was caused by human immunodeficiency virus type 1 (HIV)-associated disorders in 72% including cytomegalovirus colitis in seven patients, idiopathic colonic ulcers in five patients, and intestinal Kaposi's sarcoma in one patient. HIV-associated thrombocytopenia contributed to substantial bleeding from hemorrhoidal disease in two patients. Rebleeding occurred in four patients (22%), including hemorrhoids in three and idiopathic colonic ulcers in one. Surgery was not performed in any patient. Following the institution of ganciclovir therapy, no patient with CMV colitis had recurrent bleeding. The in-hospital mortality was high (28%), although bleeding was the direct cause of death in only one patient. Conclusions: LGIB is infrequent in patients with AIDS and is usually caused by opportunistic diseases specifically related to immunodeficiency. Although some of these conditions are potentially treatable medically, in-hospital mortality is high and long-term prognosis is poor because of AIDS-related comorbidity.

Etiology and outcome of lower gastrointestinal bleeding in patients with AIDS.

The objective of the study was to investigate bleeding (LGIB) in patients with acquired immunodeficiency syndrome (AIDS). All hospitalized AIDS patients with LGIB evaluated by the gastroenterology service at a large city-county hospital during a 6 yr period were identified by database review and by endoscopy and consultation records. Of the 691 AIDS patients seen during the study period, 18 (2.6%) (median age 41+/-7 years) were evaluated for LGIB. In these patients, LGIB was caused by human immunodeficiency virus type 1 (HIV)-associated disorders in 72% including cytomegalovirus colitis in seven patients, idiopathic colonic ulcers in five patients, and intestinal Kaposi's sarcoma in one patient. HIV-associated thrombocytopenia contributed to substantial bleeding from hemorrhoidal disease in two patients. Rebleeding occurred in four patients (22%), including hemorrhoids in three and idiopathic colonic ulcers in one. Surgery was not performed in any patient. Following the institution of ganciclovir therapy, no patient with CMV colitis had recurrent bleeding. The in-hospital mortality was high (28%), although bleeding was the direct cause of death in only one patient. LGIB is infrequent in patients with AIDS and is usually caused by opportunistic diseases specifically related to immunodeficiency. Although some of these conditions are potentially treatable medically, in-hospital mortality is high and long-term prognosis is poor because of AIDS-related comorbidity.

Faecal alpha 1 antitrypsin as a marker of gastrointestinal disease in HIV antibody positive individuals.

Hypoalbuminaemia and diarrhoea are common complications of HIV infection and substantial causes of morbidity, but the specific intestinal pathologies that cause enteric protein loss have not been clearly defined. Two hundred and twenty stool samples from patients with a variety of HIV related conditions were analysed for faecal alpha 1 antitrypsin. Patients with intestinal Kaposi's sarcoma had a significantly raised faecal alpha 1 antitrypsin value and hypoalbuminaemia. A faecal alpha 1 antitrypsin value of greater than 0.3 mg/g wet stool has a sensitivity of 94% and a specificity of 76% for the diagnosis of intestinal Kaposi's sarcoma in HIV positive individuals. Patients with cytomegalovirus and bacterial enteritis had raised faecal alpha 1 antitrypsin values but levels were normal for all other intestinal pathologies compared with pathogen negative stool. The combination of faecal alpha 1 antitrypsin concentration greater than 0.2 mg/g, a negative stool culture for enteric bacteria, and the absence of palatal Kaposi's sarcoma has a sensitivity of 55% and specificity of 88% for the diagnosis of enteric cytomegalovirus infection.

Protein-Losing Enteropathy in Acquired Immunodeficiency Syndrome due to Intestinal Kaposi's Sarcoma

Patients with the acquired immunodeficiency syndrome (AIDS) often have hypoalbuminemia. We report the case of a patient with AIDS in whom marked hypoalbuminemia developed due to a protein-losing enteropathy caused by small intestinal Kaposi's sarcoma--an entity not previously reported in AIDS. The patient presented with ankle edema, pleural effusions, and a decrease in albumin from 3.0 g/dL (30 g/L) to 1.7 g/dL (17 g/L) over one month. Protein-losing enteropathy was confirmed by a marked elevation in fecal alpha-1 antitrypsin, and extensive evaluation of the gastrointestinal tract revealed the source to be small intestinal Kaposi's sarcoma. A protein-losing enteropathy should be considered when hypoalbuminemia is encountered in a patient with AIDS.

Protein-losing enteropathy in acquired immunodeficiency syndrome due to intestinal Kaposi's sarcoma

Protein-losing enteropathy in acquired immunodeficiency syndrome due to intestinal Kaposi's sarcoma

Abdominal pain in patients with acquired immune deficiency syndrome.

The patient with acquired immune deficiency syndrome (AIDS) and abdominal pain presents the surgeon with a difficult challenge. The pain may be due to an opportunistic infection, ileus, organomegaly, or a true surgical emergency. The hospital records of 235 patients with AIDS were reviewed. Of the 29 patients with abdominal pain, 12 had infectious diarrhea, eight were diagnosed as having ileus or organomegaly, and nine had miscellaneous causes for their pain. Only five patients underwent laparotomy. Two patients were operated on for pain associated with bleeding (Meckel's diverticulum and intestinal Kaposi's sarcoma); one had a perforated duodenal ulcer and one had severe ileitis. One patient was electively operated on for Burkitt's lymphoma. Laparotomy for abdominal pain is not usually necessary in patients with AIDS. Specific recommendations for evaluation and management of these patients are offered.

Malabsorption and mucosal abnormalities of the small intestine in the acquired immunodeficiency syndrome.

Diarrhea and weight loss may accompany the acquired immunodeficiency syndrome. We studied 30 patients with the syndrome, 20 of whom had diarrhea and weight loss and 10 of whom did not. Patients with identifiable enteric infections or small intestinal Kaposi's sarcoma were excluded. Malabsorption was common in the patients with diarrhea and weight loss, as shown by abnormal D-xylose and 14C-glycerol-tripalmitin absorption tests. In these patients, duodenal biopsy specimens showed a histiocytic infiltrate containing numerous acid-fast organisms in 5 and a mild-moderate chronic inflammation in 13. In asymptomatic patients, duodenal biopsy specimens were normal in 6 and showed chronic inflammation in 4. These results suggest that malabsorption is common in patients with the acquired immunodeficiency syndrome with chronic diarrhea and may contribute to their weight loss.