S4615 Cutaneous Clues, Visceral Truths: Uncovering Kaposi’s Sarcoma in the GI Tract

Introduction: Kaposi’s Sarcoma is a soft tissue malignancy that is caused by HHV-8 infection in immunocompromised patients and is an AIDS-defining illness. Kaposi’s Sarcoma typically involves diffuse skin and in more advanced cases, visceral organ involvement including that of the GI tract. This case describes how endoscopic guided tissue sampling informed decision making for definitive management of visceral Kaposi’s Sarcoma. Case Description/Methods: Thirty-four-year-old man with no known medical history presented with worsening rash on face and body and swelling of the eyelids. Patient reported that his rash began with a small lesion next to his eye 8 months prior but had steadily been worsening. He was found to be HIV antibody positive on admission with a CD4 count of fifty. HHV-8 immunostain was positive on dermatologic punch biopsy which supported a diagnosis of Kaposi’s Sarcoma. He underwent a bronchoscopy with bronchoalveolar lavage positive for PJP and CMV, but not HHV-8. Given concern for disseminated Kaposi’s Sarcoma, he was started on doxarubicin and antiretroviral treatment for HIV. GI was consulted to evaluate concern of visceral involvement and if he would require additional chemotherapy outpatient. Esophagogastroduodenoscopy demonstrated 2 raised erythematous nodular appearing lesions at the GE junction, measuring 5 mm in size (HHV-8 immunostain positive). Colonoscopy demonstrated scattered patchy erythema with mild superficial ulceration in the rectum (HHV-8 immunostain positive). He improved with initiation of systemic doxarubicin and anti-retroviral therapy and discharged with close outpatient oncology and infectious disease follow-up for consideration of further treatment given visceral involvement. Discussion: The mainstay treatment for AIDS-related Kaposi’s Sarcoma involves anti-retroviral therapy. In cases in which there is visceral involvement, systemic chemotherapy should be considered. This case highlights the importance of gastrointestinal endoscopy to guide management of AIDS-related Kaposi’s Sarcoma. Further research is warranted to determine the optimal timing and indications for endoscopic evaluation in patients with cutaneous Kaposi’s Sarcoma.