EPIDEMIC KAPOSI'S SARCOMA WITH COLORECTAL INVOLVEMENT

Male patient, 28 years old, admitted to the emergency department with hematochezia and weight loss. Anal inspection identified darkened papular lesions in the perianal region, with thickening in the anal canal. A flexible sigmoidoscopy showed mucosal erythema extending to the mid-rectum, with a nodular lesion, irregular red surface, and a diameter of 4 cm. Histopathological examination revealed an unspecific inflammatory nature. Subsequent diagnostic work-up confirmed HIV, and antiretroviral therapy (ART) was initiated. Immunohistochemical analysis tested positive for HHV8, CD34, and D240, suggesting Kaposi's sarcoma (KS). The patient developed red papules on the anterior chest, with histopathology confirming cutaneous dissemination of the disease. Pelvic MRI revealed extensive lesions in the rectum and anal canal, mesorectal and para-aortic lymphadenopathy. Chemotherapy was initiated alongside ART. One year after starting treatment, the patient remained stable, oligossymptomatic, with clinical improvement of the initial condition, remission of papular lesions on the skin, and a reduction in rectal lesion size. CD4 count > 600, indicating disease control. Kaposi's sarcoma (KS) is an angioproliferative disease associated with infection by human herpesvirus 8 (HHV-8). HIV-associated KS (epidemic KS) is the most common form of disease. Since the introduction of ART, the incidence of KS has significantly decreased in HIV-positive patients. Cutaneous involvement is more common and is the usual initial presentation of KS. Visceral involvement frequently affects the gastrointestinal tract (GI). GI lesions may be asymptomatic or cause weight loss, abdominal pain, gastrointestinal bleeding, or intestinal obstruction. They are recognized on endoscopic examination as hemorrhagic nodules, which can be isolated or confluent, occurring in any part of the GI tract. Diagnosis should be confirmed by biopsy whenever possible. Treatment is guided by the presence or absence of symptoms. The main goals are to alleviate symptoms, prevent disease progression, and reduce tumor size. Many patients experience tumor regression with ART alone. Patients with advanced disease often require a combination of ART and chemotherapy. KS develops in immunosuppression, such as in AIDS. This case highlights the importance of considering this diagnosis in the presence of lesions of inflammatory nature.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025