Metastatic Kaposi’s Sarcoma Causing Gastrointestinal Bleeding: Report of an Unusual Case

Case Report

Austin J Gastroenterol. 2017; 4(1): 1074.

Metastatic Kaposi’s Sarcoma Causing Gastrointestinal Bleeding: Report of an Unusual Case

Mao-Yu Huang1,2, Feng-Cheng Liu³, Hong-Wei Gao4 and Tien-Yu Huang2,5*

¹Division of Gastroenterology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taiwan

²Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, Taiwan

3Division of Rheumatology/Immunology and Allergy, Tri- Service General Hospital, Taiwan

4Department of Pathology, Tri-Service General Hospital, Taiwan

5Taiwan Association for the Study of Small Intestinal Diseases, Taiwan

*Corresponding author: Tien-Yu Huang, Division of Gastroenterology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan

Received: December 01, 2016; Accepted: February 07, 2017; Published: February 09, 2017


Kaposi’s sarcoma is a vascular tumor associated with human herpesvirus 8 (HHV8) infections that most commonly involve the skin. Kaposi’s sarcoma with the gastrointestinal tract is not rare in acquired immunodeficiency syndrome and can also occur in immunosuppressed patients. These patients may present with vague and variable clinical manifestations. Herein, we report a case of a 70-year-old man with Sjogren’s syndrome and cutaneous Kaposi sarcoma who presented with gastrointestinal bleeding. On upper endoscopy, infiltrative, circumferential, reddish polypoid lesion involving the body and antrum of the stomach was seen. Histologic examination revealed spindle cell proliferation, and immunohistochemistry stains for human herpes virus-8 and CD34 were positive, supporting the diagnosis of metastatic Kaposi’s sarcoma. Following this, we present an overview of literature on gastrointestinal Kaposi’s sarcoma with emphasis on diagnosis and management.

Keywords: Kaposi’s sarcoma; Upper gastrointestinal endoscopy; Gastrointestinal tumor


Kaposi sarcoma (KS) is a multifocal low-grade vascular malignancy that is associated with Human Herpesvirus-8 (HHV8) infection [1]. The first description of this tumor dates back to 1872 and was made by Dr. Moritz Kaposi, a Hungarian dermatologist who described 5 cases of “idiopathic multiple pigmented sarcomas of the skin”. Four distinct forms have been characterized including classic KS, endemic or African KS, organ transplant-associated KS, and AIDS-related KS [2,3]. KS is the most common malignancy in patients with AIDS, especially among men who have sex with men (MSM) and low CD4 count of <100 cell/μL. It also develops in the setting of advanced immune suppression frequently [3,4,5].

Skin lesions are the most common manifestation in patients with KS, typically the skin of the lower extremities, face, trunk and genitalia. Visceral involvement is also frequent, affecting most commonly the gastrointestinal tract (40%) and lungs (30%) [6,7]. Most patients with GI involvement are asymptomatic, and therefore, most visceral KS remain unidentified [4]. However, it may present with nonspecific symptoms such as weight loss, diarrhea, abdominal pain and Gastrointestinal bleeding [8]. Obstruction, perforation, intussusception, and protein-losing enteropathy are infrequent complications associated with advance disease and high GI burden [9].

We report a rare case of GI-KS presenting as upper GI bleeding in Sjogren’s syndrome individual. Prompt diagnosis and early initiation of therapy are the cornerstones for management of this potentially severe disease.

Case Presentation

A 70-year-old male had presented with progressively weakness, dizziness, and melena for 1 week. He had past medical history of type 2 diabetes, Sjogren’s syndrome and cutaneous Kaposi sarcoma diagnosed by skin biopsy 1 year previously. Physical examinations revealed pallor conjunctiva and erythematous plaques lesions on his lower extremities (Figure 1). Laboratory data showed hemoglobin level of 7.3 g/dL and positive result of the fecal occult blood test. The esophagogastroduodenoscopy disclosed numerous 1 to 2cm, polypoid reddish lesions with ulceration in the stomach (Figure 2 and 3). Biopsy specimens were obtained from the nodular lesions. The pathologic result of biopsy showed moderate chronic inflammation and proliferation of spindle cells with vascular slits and hemorrhage, consistent with Kaposi’s sarcoma. Immunohistochemistry stains for human herpes virus-8 and CD34 were positive, supporting the above diagnosis (Figure 4 and 5). The patient received blood transfusion and proton-pump inhibitor administration. Systemic treatment with doxorubicin was recommended but the patient hesitated the side effects of chemotherapy. His melena and symptoms related to anemia temporarily improved after conservative medical treatment.