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Case Report
Acquired immunodeficiency syndrome related Kaposi sarcoma of the rectum in the absence of cutaneous manifestation
1 Department of Internal Medicine, The University of Texas at Austin Dell Medical School, Austin, Texas, United States
2 Department of Diagnostic Medicine, The University of Texas at Austin Dell Medical School, Austin, Texas, United States
3 Department of Internal Medicine, Division of Gastroenterology and Hepatology, The University of Texas at Austin Dell Medical School, Austin, Texas, United States
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Paul Guzik
1500 Red River St., Austin, Texas 78701,
United States
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Article ID: 101181Z01PG2020
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Guzik P, Kim C, Rivera-Begeman A, Tang D. Acquired immunodeficiency syndrome related Kaposi sarcoma of the rectum in the absence of cutaneous manifestation. Int J Case Rep Images 2020;11:101181Z01PG2020.ABSTRACT
Introduction: In developed countries, the incidence of Kaposi sarcoma (KS) has declined substantially with more widespread use of antiretroviral therapy (ART). The initial presentation of KS is usually cutaneous lesions. Uncommonly, KS is discovered in visceral organs without skin involvement. Isolated KS of the rectum is rare.
Case Report: A 41-year-old man with history of iron deficiency anemia and external hemorrhoids presented with worsening rectal bleeding over three years with associated tenesmus and weight loss. On exam, no skin lesions were identified. Hemoglobin was 5.4 g/dL. Rapid human immunodeficiency virus (HIV) screen was positive. Absolute CD4 count was 37/uL. HIV-1 viral load was 328,790 copies/mL. Computed tomography (CT) scan revealed an irregular, circumferential 7 cm rectal mass with associated rectal and pelvic lymphadenopathy. Colonoscopy revealed a non-obstructing, circumferential, friable, ulcerated, nodular mass from the dentate line to 14 cm. Biopsy revealed ulcerated tissue and spindle cell proliferation with HHV-8 positive endothelial cells.
Conclusion: We describe the case of a 41-year-old man with newly diagnosed HIV/AIDS and latent syphilis who presented with rectal bleeding and was found to have KS of the rectum with no prior history of skin lesion nor any evidence of cutaneous disease seen on thorough physical examination. Although uncommon, KS can present on visceral surfaces, such as the gastrointestinal (GI) tract, in the absence of cutaneous lesions. Isolated anorectal KS in the absence of skin involvement is rarely seen. Despite an endoscopic appearance which mimics adenocarcinoma, rectal KS should remain in the differential for rectal mass in an immunosuppressed patient, even without typical cutaneous lesions.
Keywords: Colonoscopy, HIV/AIDS, Kaposi sarcoma, Rectal mass
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Author Contributions
Paul Guzik - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Christopher Kim - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Amanda Rivera-Begeman - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
David Tang - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2020 Paul Guzik et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
