Visceral Kaposi sarcoma, an unusual VIH debut

Introduction: Kaposi sarcoma (KS) is a low degree neoplasia in the vascular endothelium associated with herpes 8 virus (HHV8). There are 4 subtypes: epidemic (HIV-related), classic, endemic and iatrogenic. It commonly appears with cutaneous manifestations and occasionally visceral involvement, with the digestive involvement being the most frequent. We report a 33-year-old male with no relevan medical history who checked for abdominal pain and anemia.

Endoscopy: An endoscopy is performed, revealing in almost the entire gastric cavity, except partially in the antrum, a mucosa of thickened, erythematous and friable appearance, with mamelons and ulcerated areas. An ileocolonoscopy is then performed, observing raised, nodular, reddish lesions all throughout the colon including the anal canal, some of which are ulcerated with fibrin spots on normal mucosa. Histologically, there is evidence of spindle cell tumor proliferation with positive HHV8 immunohistochemistry, which is compatible with KS. HIV serology was performed, coming out positive (79 CD4 and viral load of 4.6 logarithms). Antiretroviral treatment and liposomal doxorubicin were initiated, with good evolution.

Conclusion: There are three types of KS endoscopic lesions: maculopapular, which is the most frequent with reddish, raised and millimetric lesions; polypoid, with>1cm dark nodular lesions; and vulcanoid, which reveals>1cm nodular lesions with a central depression. We consider this case of interest both due to the HIV debut as KS with no apparent infectious history and the endoscopic involvement with a vulcanoid type predominance, showing the importance of anatomopathological studies with HHV8 positivity being fundamental.

Publication History

Article published online:
27 March 2025