A 47-year-old Hispanic man who had no significant past medical history was admitted
to the Wyckoff Heights Medical Center with nausea and headache, which were followed
by seizures. The patient had had significant weight loss and an abdominal computed
tomographic scan revealed thickening of the stomach wall ([Figure 1]). The patient initially refused upper endoscopy but agreed to undergo video capsule
endoscopy, which showed lesions suggestive of Kaposi’s sarcoma in the small bowel
([Figure 2]). He subsequently agreed to undergo upper endoscopy for biopsy of the lesion and
this examination revealed purplish nodular lesions in the esophagus, stomach, and
duodenum. Push-enteroscopy showed typical Kaposi’s lesions in the jejunum ([Figure 3]). A biopsy of one of the lesions showed spindle-cell proliferation with vascular
splits, an appearance consistent with a diagnosis of Kaposi’s sarcoma ([Figure 4]). Immunohistochemical testing for human herpesvirus 8 (HHV-8) showed a strong positive
reaction ([Figure 5]). The patient was subsequently found to have a very low absolute CD4 count and he
tested positive for human inmmunodeficiency virus, with a high viral load. The patient
was started on highly active antiretroviral therapy (HAART) and was feeling much better
when seen on follow-up 2 weeks later.
Endoscopy_UCTN_Code_CCL_1AC_2AC
Figure 1 A computed tomographic scan of the abdomen showed thickening of the stomach wall.
Figure 2 Small-bowel capsule endoscopy showed typical Kaposi’s sarcoma lesions.
Figure 3 Immunohistochemical testing for human herpes virus 8 (HHV-8) showed a strong positive
reaction.
Figure 4 A high-power histological view of a biopsy specimen of one of the Kaposi’s sarcoma
lesions.
Figure 5 Push-enteroscopic view showing a Kaposi’s sarcoma lesion in the jejunum.
