Classic Kaposi’s sarcoma and involvement of the small intestine as shown by capsule endoscopy

Table of Contents

A 65-year-old HIV-negative man presented at the Dermatology Department of our Hospital with skin lesions typical of classic Kaposi’s sarcoma. Although he was asymptomatic as regards the gastrointestinal tract he underwent gastroscopy and colonoscopy, as Kaposi’s sarcoma can affect the gastrointestinal mucosa. Indeed, protruding red lesions at the duodenum ([Fig. 1]) and the colonic mucosa ([Fig. 2]) were noted. The patient then underwent small-bowel capsule endoscopy, which revealed even more prominent lesions in the jejunum ([Fig. 3]), as well as ulcerated ones in the ileum ([Fig. 4]).

Fig. 1 Kaposi’s sarcoma of the duodenum.

Fig. 2 Kaposi’s sarcoma of the colon.

Fig. 3 Kaposi’s sarcoma of the jejunum.

Fig. 4 Ulcerated Kaposi’s sarcoma of the ileum.

Kaposi's sarcoma has been classified into four clinical variants: classic or Mediterranean; endemic or African; epidemic or AIDS-related; iatrogenic or immunosuppression-related [1] [2]. Human herpesvirus 8 (HHV-8), has been found in all these variants.

Classic Kaposi’s sarcoma, as originally described, was a relatively indolent disease affecting elderly men from the Mediterranean region, or those of Eastern European descent. Kaposi’s sarcoma are nodules or blotches that may be red, purple, brown, or black, and are usually papular (i. e. palpable or raised). They are typically found on the skin, but spread elsewhere is common, especially the mouth, gastrointestinal tract, and respiratory tract. Gastrointestinal lesions may be silent or may cause weight loss, pain, nausea/vomiting, diarrhea, bleeding, malabsorption, or intestinal obstruction. Reports of gastrointestinal Kaposi’s sarcoma in the literature are sparse, and according to our knowledge small-bowel classic Kaposi’s sarcoma has only been reported once before in a Peruvian journal [3]. It may be that small-bowel lesions were undetectable, as up to the advent of capsule endoscopy there were no means of visualizing the small intestine. Our case suggests that the small bowel should also be investigated in patients with Kaposi’s sarcoma, as even more prominent lesions than those seen in the rest of the gastrointestinal tract can be detected.

Endoscopy_UCTN_Code_CCL_1AC_2AC

References

• 1 Antman K, Chang Y. Kaposi’s sarcoma.  New Engl J Med. 2000;  342 1027-1038
• 2 Szajerka T, Jablecki J. Kaposi’s sarcoma revisited.  AIDS Rev. 2007;  9 230-236
• 3 Mohanna S, Sanchez J, Ferrufino J. et al . Classic Kaposi sarcoma in jejunum: case report.  Rev Gastroenterol Peru. 2005;  25 285-287