Gastric Kaposi Sarcoma With Distinct “Lobster‐Like” Endoscopic Lesions in a Human Immunodeficiency Virus‐Positive Patient

TL;DR

This paper reports a rare case of gastric Kaposi Sarcoma in an HIV-positive patient with a unique 'lobster-like' appearance, emphasizing the need for early endoscopic evaluation in HIV patients.

Contribution

The paper documents the first report of gastric Kaposi Sarcoma with a novel 'lobster-like' endoscopic appearance.

Findings

The patient had gastric Kaposi Sarcoma confirmed by histopathology showing CD34 and HHV-8 positive endothelial cells.

The 'lobster-like' appearance is likely due to submucosal vascular proliferation, reflecting the tumor's vascular origin.

The case highlights the importance of early endoscopic evaluation in HIV-infected individuals with unexplained GI symptoms.

Abstract

Kaposi Sarcoma (KS) is a rare vascular tumor linked to Human Herpesvirus‐8 (HHV‐8) infection, most often affecting immunocompromised patients with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS). Gastrointestinal KS (GI‐KS) is frequently underdiagnosed, particularly in resource‐limited settings, and may present with nonspecific symptoms. We describe a 52‐year‐old HIV‐positive male with advanced immunosuppression (CD4 count: 34 cells/µL, viral load: 236,670 copies/mL) who presented with abdominal pain, weight loss, and violaceous cutaneous lesions. Upper GI endoscopy revealed multiple reddish nodular gastric lesions with a distinctive “lobster‐like” morphology. Histopathology showed abnormal vascular proliferation, with endothelial cells positive for CD34 and HHV‐8, confirming gastric KS. Colonoscopy was unremarkable. The patient received HAART only, without systemic chemotherapy, and refused further treatment and follow‐up. The coexistence of gastric and cutaneous KS in this patient reflects disseminated disease and highlights the importance of early endoscopic evaluation in HIV‐infected individuals with unexplained GI complaints. This case adds to the limited literature on gastric KS in the Middle East and documents an unusual endoscopic appearance that may aid in earlier recognition. To our knowledge, this is the first report of a gastric KS lesion with a novel “lobster‐like” appearance. This appearance likely reflects the tumor's vascular origin, producing bilateral, claw‐shaped mucosal elevations due to submucosal vascular proliferation. Greater awareness of such presentations can facilitate timely diagnosis, multidisciplinary management, and improved outcomes in advanced HIV.

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