A 65-year-old HIV-negative man presented at the Dermatology
Department of our Hospital with skin lesions typical of classic Kaposi’s
sarcoma. Although he was asymptomatic as regards the gastrointestinal tract he
underwent gastroscopy and colonoscopy, as Kaposi’s sarcoma can affect the
gastrointestinal mucosa. Indeed, protruding red lesions at the duodenum ([Fig. 1]) and the colonic mucosa ([Fig. 2]) were noted. The patient then underwent
small-bowel capsule endoscopy, which revealed even more prominent lesions in
the jejunum ([Fig. 3]), as well as ulcerated ones
in the ileum ([Fig. 4]).
Fig. 1 Kaposi’s sarcoma
of the duodenum.
Fig. 2 Kaposi’s sarcoma
of the colon.
Fig. 3 Kaposi’s sarcoma
of the jejunum.
Fig. 4 Ulcerated Kaposi’s
sarcoma of the ileum.
Kaposi's sarcoma has been classified into four clinical
variants: classic or Mediterranean; endemic or African; epidemic or
AIDS-related; iatrogenic or immunosuppression-related [1]
[2]. Human herpesvirus 8 (HHV-8),
has been found in all these variants.
Classic Kaposi’s sarcoma, as originally described, was a
relatively indolent disease affecting elderly men from the Mediterranean
region, or those of Eastern European descent. Kaposi’s sarcoma are
nodules or blotches that may be red, purple, brown, or black, and are usually
papular (i. e. palpable or raised). They are typically found on the
skin, but spread elsewhere is common, especially the mouth, gastrointestinal
tract, and respiratory tract. Gastrointestinal lesions may be silent or may
cause weight loss, pain, nausea/vomiting, diarrhea, bleeding, malabsorption, or
intestinal obstruction. Reports of gastrointestinal Kaposi’s sarcoma in
the literature are sparse, and according to our knowledge small-bowel classic
Kaposi’s sarcoma has only been reported once before in a Peruvian journal
[3]. It may be that small-bowel lesions were
undetectable, as up to the advent of capsule endoscopy there were no means of
visualizing the small intestine. Our case suggests that the small bowel should
also be investigated in patients with Kaposi’s sarcoma, as even more
prominent lesions than those seen in the rest of the gastrointestinal tract can
be detected.
Endoscopy_UCTN_Code_CCL_1AC_2AC
