Gastrointestinal Kaposi's Sarcoma Presenting as Ileocolic Intussusception
A 42-year-old male presented with one week history of nausea, vomiting and peri-umbilical abdominal pain of few hours duration. He also had associated nonbloody diarrhea. He denies viral prodrome, sick contacts, recent travel, food poisoning, or any recent antibiotic use. Past medical history was significant for human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) with last CD4 count of 28 and viral load of 13,949. On physical examination, vital signs were within normal limits except blood pressure of 87/58 mmHg. Abdominal examination was significant for tenderness around peri-umbilical region and in right-lower quadrant without rebound tenderness. Bowel sounds were absent. Initial laboratory work was remarkable for hyponatremia (125 mmol/L) and hypokalemia (3.0 mmol/L). Computed tomography (CT) of abdomen with contrast showed long segment of small bowel that was seen projected into the lumen of a distended mobile cecum consistent with large ileo-colic intussusception []. It was also noted in several areas of nodular thickening in the gastric wall, small bowel, and ascending colon. Differential diagnosis at that time was tuberculosis, lymphoma, and KS. During the hospital course, patient was treated conservatively; he was kept nothing by mouth (NPO), was given intravenous fluids, and nasogastric suction was placed. Esophagogastroduodenoscopy (EGD) showed esophageal candidiasis and multiple raised erythematous lesions and masses distributed throughout the stomach with ulcerations. The lesions were nodular and polypoid and have a vascular appearance. No bleeding and no stigmata of recent bleeding were noted. The lesions ranged from less than 1 cm to approximately 4 cm in diameter []. Biopsies show KS [Figure and ] and tumor cells were positive for human herpes virus 8 (HHV-8). Patient's symptoms improved with conservative management and he was discharged on highly active antiretroviral therapy (HAART). Two weeks later, the patient was readmitted to our hospital with similar symptoms. Repeat CT-scan showed recurrent ileo-colic intussusception. Small-bowel series showed incomplete small bowel obstruction with spontaneous resolution of intussusception. Patient was discharged to continue HAART therapy and doxorubicin chemotherapy on weekly basis was added to his management.