PICTURES IN DIGESTIVE PATHOLOGY

 

Upper gastrointestinal bleeding due to gastric and duodenal Kaposi's sarcoma

Hemorragia digestiva alta secundaria a sarcoma de Kaposi gástrico y duodenal

 

 

Laura Bello Rodríguez¹, Remedios Pardeiro Pértega², Ignacio Couto Wörner², Pilar Vázquez Rodríguez¹, Soledad López Calvo¹, María Ángeles Castro Iglesias¹, Álvaro Mena de Cea¹, Pedro Alonso Aguirre² and José Domingo Pedreira Andrade¹

¹Service of Internal Medicine B (HIV Unit). ²Service of Gastroenterology. University Hospital of A Coruña. Spain

 

 

Case report

A 30-year-old homosexual male was recently diagnosed with HIV infection (category A2). He was been admitted into the hospital because of anal pain and diarrhea of 8 months. He presented purplish cutaneous lesions, laterocervical adenopathies and a palpable anal mass. The rest of physical exploration did not reveal any other significant alteration. The amount of CD4 was 350 cells/mL and the viral load of 10,000 copies/mL. Fecal cultures were negative. A colonoscopy was performed and detected an ulcerated rectal mass that was biopsied (Fig. 1). He presented an episode of hematemesis so it was performed an upper endoscopy which demonstrated the presence of lesions suggestive of Kaposi's in the stomach (Fig. 2) and duodenum (Fig. 3). The definitive anatomopathologic diagnosis of the cutaneous anal lesion, gastric biopsy and adenopathies was Kaposi's' sarcoma. The patient began antiretroviral treatment and chemotherapy with liposomal doxorubicin and radiotherapy.

 

 

Discussion

Kaposi's sarcoma is a vascular tumor described first in 1872. It is associated with the immunosuppressive state in patients affected by infection with HIV. It usually appears as small purplish cutaneous lesions although it can affect other mucosa, organs and lymphatic system. Postmortem studies suggest the presence of visceral involvement in more than 75% of the cases, being the lungs and gastrointestinal tract the most common ones. It can affect any part of the digestive tract, from the oropharynx to the rectum. They have been described cases of hepatic, splenic and pancreatic disease (1). Gastrointestinal Kaposi's sarcoma frequently has a silent clinical course although it can cause abdominal pain, gastrointestinal bleeding and intestinal obstruction (2). Endoscopically it can presents as a purplish nodule, a polipoid mass or a hemorragic macule (3).

 

References

1. Friedman SL. Kaposi's sarcoma and lymphoma of the gut in AIDS. Baillieres Clin Gastroenterol 1990;4:455-75.         [ Links ]

2. Kaplan LD. HIV associated neoplasia. En: Volberding PA, Sande MA, Greene WC, Gallant J, editors. Global HIV/AIDS Medicine. Saunders; 2008. p. 463-74.         [ Links ]

3. Friedman SL, Wrigth TL, Altman DF. Gastrointestinal Kaposi's sarcoma in patients with acquired immunodeficiency syndrome. Gastroenterology 1985;89:102-8.         [ Links ]