S3759 Beyond the Skin: Unveiling Advanced Kaposi Sarcoma With Gastrointestinal Involvement in an HIV/AIDS Patient

Introduction: Kaposi sarcoma is an angio-proliferative tumor caused by Human Herpesvirus-8 and occurs at a rate of about 6 cases per million people per year. Even though gastrointestinal involvement is not rare, it is usually asymptomatic, and thus thought to be underdiagnosed, 79% being clinically silent. If symptomatic, patients with gastrointestinal involvement of KS present with abdominal pain, nausea, vomiting, and iron deficiency anemia. Diagnosis is made by endoscopy with biopsy for the identification of histological and immunohistochemical markers. Case Description/Methods: A 36-year-old African American man with a PMHx of HIV/AIDS (on HAART) and schizophrenia was admitted to the Emergency Department for LLE pain and bleeding from a left thigh wound with chest x-ray findings of large layering left-sided pleural effusion with compressive atelectasis of the underlying lung 2 days after admission, he developed hypotension secondary to acute blood loss with an unclear source of bleeding, however, FiOBT was positive. There was an acute drop in hemoglobin from 7.3 to 5.8. Blood transfusions were started after type and screen. Endoscopy was done and revealed gastric masses approximately 1 cm in size and biopsies were taken which later showed gastric hyperplastic changes. Due to superimposed infection from pseudomonas aeruginosa of the wounds on his lower extremities, Computed tomography was done and showed multiple round well-circumscribed lytic osseous lesions, extensive subcutaneous nodules within the bilateral thighs with increased subcutaneous edema, and interval development of diffuse ascites or mesenteric edema. Palliative care was initiated by the patient and family due to pain intolerance, so all active management was withdrawn. Discussion: The onset of the HIV epidemic in 1981 led to the discovery of AIDS-associated Kaposi Sarcoma. In 1994, Chang, et al., isolated a DNA sequence from Kaposi sarcoma tissue, which revealed the KS-associated herpesvirus, or HHV8. Affected individuals usually present with cutaneous disease/visceral involvement, where the gastrointestinal tract is the most common extracutaneous site. Screening endoscopies in these patients has been suggested for early detection and treatment to improve outcomes. Remarkably, expression of HHV-8 latent nuclear antigen has shown to be consistent with a diagnosis of gastric Kaposi Sarcoma. Previous studies have shown that dual treatment with HAART and systemic chemotherapy has been associated with improved morbidity and mortality in individuals with visceral Kaposi sarcoma.