NIGERIAN JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY

CASE REPORT
Year
: 2020  |  Volume : 12  |  Issue : 1  |  Page : 28--30

AIDS-associated Kaposi sarcoma mimicking bleeding peptic ulcer disease


Ayanfe Omololu1, Barka Kwaghe2, Pantong Mark3, Simji Gomerep4, Nathan Shehu4,  
1 Department of Internal Medicine, Infectious Diseases Unit, Jos University Teaching Hospital, Jos; Department of Internal Medicine, Federal Medical Center, Abeokuta, Ogun State, Nigeria
2 Department of Histopathology, Histopathology Unit, Jos University Teaching Hospital, Jos, Nigeria
3 Department of Internal Medicine, Gastroenterology Unit, Jos University Teaching Hospital, Jos, Nigeria
4 Department of Internal Medicine, Infectious Diseases Unit, Jos University Teaching Hospital, Jos, Nigeria

Correspondence Address:
Dr. Ayanfe Omololu
Department of Internal Medicine, Federal Medical Center, Abeokuta, Ogun State
Nigeria

Abstract

Kaposi sarcoma (KS) was the first AIDS defining malignancy described, and it commonly involves the skin, although visceral lesions exist. Visceral KS lesions are easy to miss, especially when symptoms are atypical or suggestive of another condition. This is a case of KS of the stomach in an HIV/AIDS patient presenting with symptoms, suggestive of bleeding peptic ulcer disease.



How to cite this article:
Omololu A, Kwaghe B, Mark P, Gomerep S, Shehu N. AIDS-associated Kaposi sarcoma mimicking bleeding peptic ulcer disease.Niger J Gastroenterol Hepatol 2020;12:28-30


How to cite this URL:
Omololu A, Kwaghe B, Mark P, Gomerep S, Shehu N. AIDS-associated Kaposi sarcoma mimicking bleeding peptic ulcer disease. Niger J Gastroenterol Hepatol [serial online] 2020 [cited 2020 Sep 18 ];12:28-30
Available from: http://www.njghonweb.org/text.asp?2020/12/1/28/284721


Full Text



 Introduction



Kaposi sarcoma (KS) was first described in 1872 by Moritz Kaposi, but HIV/AIDS-associated KS was first described in 1981 in some homosexual men in the United States.[1] This form is most common and aggressive, with a very high prevalence before the advent of highly active antiretroviral therapy (HAART), which has changed since its improved availability.[2] However, this is not the case in most developing countries.[3] KS lesions involve commonly the skin, but mucosal surfaces and viscera can also be affected.[4] Mostly, cutaneous lesions have been reported from Nigerian studies, with only a few reporting visceral lesions.[5],[6],[7] High index of suspicion is required to make a diagnosis of visceral KS in HIV/AIDS patients, due to their atypical presentation. KS involving the gastrointestinal tract (GIT) may be asymptomatic or present with nonspecific symptoms. Patient may present with nausea, vomiting, dyspepsia, abdominal pains, or diarrhea.[8] We report the case of an HIV-positive patient with GI KS, presenting with symptoms suggestive of peptic ulcer disease (PUD).

 Case Report



A 46-year-old HIV-positive man, diagnosed and commenced on HAART (TDF/3TC/EFV) 5 months previously, presented at the Gastroenterology Clinic with complaints of epigastric and periumbilical pains: sharp in nature, moderately severe, intermittent, exacerbated by skipping meals, and relieved by eating and analgesics. There was associated history of infrequent postprandial vomiting that seldom contained blood streaks and occasional passage of stools stained with fresh blood. There was no history suggestive of nonsteroidal anti-inflammatory drug abuse. The patient had a history of such symptoms in the past and had been on treatment for PUD. There was no history of cough, breathlessness, drenching night sweats, or weight loss. On examination, he was not pale, anicteric, afebrile, with no significant peripheral lymphadenopathy. Abdominal examination revealed moderate tenderness in the periumbilical area, with no palpable organomegaly. The patient had no cutaneous lesions and no other significant findings. An abdominopelvic ultrasound showed a left hypochondrial mass with multiple adenopathy [Figure 1]. Due to persistent nature of his symptoms, an upper GI endoscopy was performed, displaying extensive gastric lesions. Histology revealed sheets of proliferating plump spindle cells with slit-like vascular spaces containing blood between them, invading the lamina propria of the gastric mucosa, consistent with KS [Figure 2]. CD4 count was 87 cells/mm3, and he was scheduled for viral load estimation. Albumin was 24 g/L (35–50) and alkaline phosphatase was 555 IU/L (21–92 IU/L). Peripheral blood film showed macrocytes and lymphocytosis, while other full blood count parameters were normal. ESR was 106 mm/h (Westergren method). Electrolytes were essentially normal. A diagnosis of GI KS was made, and the patient commenced on chemotherapy: 6 courses of intravenous paclitaxel 135mg/M2 given every 3 weeks, while ensuring compliance with ART. The patient is presently on chemotherapy and is doing quite well with resolution of symptoms, better appetite, and weight gain.{Figure 1}{Figure 2}

 Discussion



KS is an intermediate-grade angioproliferative tumor and the most common malignancy seen in people living with HIV/AIDS.[9] Cutaneous lesions are more common than visceral lesions, which commonly involve the GIT and lungs. GIT lesions can affect any part and can do so in the absence of mucocutaneous lesions.[8] Low CD4 counts, high viral loads, cutaneous lesions, male homosexuals, and not being on ART have been associated with GI KS lesions. While among patients without cutaneous lesions, CD4 count <100 cells/μL and male homosexuals were independently associated with GI KS,[10] in keeping with findings from our patient, who had no cutaneous lesions but had a CD4 count of 87 cells/mm3.

GI lesions are usually asymptomatic, making it difficult to make a diagnosis based on typical clinical features alone. A high index of suspicion is required when HIV patients present with suggestive symptoms as our patient did. Patients presenting with alarm signs related to the GIT or persistence of seemingly trivial or atypical symptoms might benefit from further evaluation, including endoscopy and biopsy. GI KS can present with significant complications, including upper GI bleeding as presented in our report, perforation, and GI obstruction among others.[8] There is a paucity of information in the local literature about visceral KS. A hospital-based retrospective study found 182 cases of HIV-associated KS, with only 6% of these having mucocutaneous and visceral involvement and 3.9% having purely visceral involvement (5 lung and 2 GIT).[7] Another study found nine cases of GI KS in about 98 HIV-positive patients with KS.[6] Although these lesions are rare, they are not that uncommon.

 Conclusion



It would be important for clinicians to be aware of the various ways visceral KS, especially GI KS can present, to intervene early and forestall complications.

Acknowledgments

We acknowledge the patient who gave us the permission to share his peculiar case report with others in the medical world, in a bid to facilitate knowledge and patient care. We also acknowledge all the people involved in our various teams in the management of the patient and subsequent production of this work.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Friedman-Kien A, Laubenstein L, Marmor M, Hymes K, Green J, Ragaz A, et al. Kaposis sarcoma and pneumocystis pneumonia among homosexual men – New York City and California. MMWR Morbidity Mortality Weekly Report 1981;30:305-8.
2Franceschi S, Maso LD, Rickenbach M, Polesel J, Hirschel B, Cavassini M, et al. Kaposi sarcoma incidence in the Swiss HIV Cohort Study before and after highly active antiretroviral therapy. Br J Cancer 2008;99:800-4.
3Sasco AJ, Jaquet A, Boidin E, Ekouevi DK, Thouillot F, Lemabec T, et al. The challenge of AIDS-related malignancies in sub-Saharan Africa. PLoS One 2010;5:e8621.
4Pantanowitz L, Dezube BJ. Kaposi sarcoma in unusual locations. BMC Cancer 2008;8:190.
5Agaba P, Sule H, Ojoh R, Hassan Z, Apena L, Mu'Azu MA, et al. Presentation and survival of patients with AIDS-related Kaposi's sarcoma in Jos, Nigeria. Int J STD AIDS 2009;20:410-3
6Ahmed A, Muktar H. Epidemiology and treatment of Kaposi's sarcoma in HIV-1 infected individuals in a poor resource setting. Global View of HIV Infection. InTech; 2011.
7Akinde O, Obadofin O, Adeyemo T, Omoseebi O, Ikeri N, Okonkwo I, et al. Kaposi sarcoma among HIV infected patients in Lagos university teaching hospital, Nigeria: A 14-year retrospective clinicopathological study. J Skin Cancer 2016;2016.
8Attia S, Dezube BJ, Torrealba JR, Sosman JM, McHaffie DR, Pfau PR, et al. AIDS-related Kaposi's sarcoma of the gastrointestinal tract. J Clin Oncol 2010;28:e250-1.
9Mocroft A, Kirk O, Clumeck N, Gargalianos-Kakolyris P, Trocha H, Chentsova N, et al. The changing pattern of Kaposi sarcoma in patients with HIV, 1994–2003: The EuroSIDA Study. Cancer 2004;100:2644-54.
10Nagata N, Shimbo T, Yazaki H, Asayama N, Akiyama J, Teruya K, et al. Predictive clinical factors in the diagnosis of gastrointestinal Kaposi's sarcoma and its endoscopic severity. PLoS One 2012;7:e46967.