Atypical Manifestation of Disseminated Gastrointestinal Kaposi Sarcoma in a Newly Diagnosed HIV Patient: A Case Report

TL;DR

A rare case of Kaposi sarcoma in a newly diagnosed HIV patient without HHV-8 infection is reported, highlighting unusual gastrointestinal symptoms and the importance of early diagnosis.

Contribution

This case report presents an atypical manifestation of disseminated gastrointestinal Kaposi sarcoma in an HHV-8-negative, newly diagnosed HIV patient.

Findings

Disseminated gastrointestinal Kaposi sarcoma can occur in HHV-8-negative patients with late HIV diagnosis.

Endoscopic evaluation confirmed gastrointestinal lesions in a patient with undiagnosed HIV.

Combination therapy with HAART and liposomal doxorubicin stabilized the patient's condition.

Abstract

Kaposi sarcoma (KS) is a multifocal angioproliferative disorder linked to Human Herpesvirus-8 (HHV-8), presenting in four forms: classic, endemic, iatrogenic, and AIDS-related. AIDS-related KS remains prevalent among HIV-positive individuals despite widespread use of antiretroviral therapy. Gastrointestinal (GI) involvement is the most common extracutaneous manifestation, primarily affecting the upper GI tract. It is often asymptomatic and typically requires endoscopic evaluation. While commonly associated with advanced HIV, GI KS can occasionally precede an HIV diagnosis. Despite its strong link to HHV-8, disseminated KS may develop in HHV-8–negative patients with late HIV diagnoses, raising concerns about AIDS progression. Management primarily includes highly active antiretroviral therapy (HAART), while liposomal doxorubicin is reserved for extensive disease to ensure symptom control, lesion regression, and improved survival.

This case report describes a rare presentation of disseminated GI KS in an HHV-8–negative patient newly diagnosed with HIV, indicating potential AIDS progression. The patient exhibited violaceous cutaneous lesions and GI symptoms, including abdominal pain and dysphagia. Endoscopy revealed esophageal masses and ulcer-like lesions in the stomach and duodenum, with histology and IHC confirming KS despite negative HHV-8 status. Management included HAART and liposomal doxorubicin, with close IRIS monitoring. The patient remained hemodynamically stable and was discharged on HAART, chemotherapy, and prophylactic antifungal and antibiotic therapies following negative cultures and stable clinical status.

This case highlights the need for vigilance in the atypical manifestation of HHV-8–negative disseminated GI KS in an undiagnosed HIV-positive patient, emphasizing the clinical presentation, diagnostic approach, and disease management. The patient's stabilization underscores the importance of early recognition, comprehensive diagnostic evaluation, and a multidisciplinary approach in managing complex cases.

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