Iatrogenic Kaposi's Sarcoma: A Unique Case Unraveling Gastrointestinal Manifestations and Therapeutic Implications

Abstract

Kaposi's sarcoma (KS), linked to human herpesvirus 8 (HHV8), manifests in various clinical forms with iatrogenic KS uniquely tied to immune dysregulation induced by medical interventions. This study describes a 58-year-old male of sub-Saharan origin with a medical history of segmental and focal hyalinosis treated with methylprednisolone and mycophenolate mofetil. The patient developed skin lesions on both thighs, accompanied by post-prandial vomiting and abdominal pain. Clinical examination revealed flesh-colored nodules on the thighs and inguinal lymphadenopathy. Biopsy confirmed the diagnosis of KS, exhibiting positive nuclear labeling to anti-HHV8 and negative HIV serology. Additionally, radiological findings from the thoracic-abdominal-pelvic computed tomography (CT) scan significantly contribute to our understanding of the multiorgan involvement associated with KS in this case, providing valuable insights for diagnosis and therapeutic considerations. This case highlights the iatrogenic subtype of KS, linked to immunosuppression from prior medical interventions. Notably, gastrointestinal involvement was evident, with lesions in the stomach and small intestine. Intravenous paclitaxel administration resulted in a positive clinical response. This study underscores the importance of clinical vigilance, endoscopic evaluation, and early intervention in the nuanced diagnosis and management of iatrogenic KS.

Keywords: dermatology; gastrointestinal; human herpesvirus 8; iatrogenic; iatrogenic kaposi sarcoma; immunosuppression; kaposi; kaposi sarcoma hiv negative; kaposi sarcoma paclitaxel; skin lesions.

Figure 1. Dermatological manifestations of Kaposi's sarcoma.

The lesions presented as centimeter-sized, violaceous erythematous nodules with warty surface, firm consistency, confluent in patches, located on both thighs.

Figure 2. The thoracic-abdominal-pelvic computed tomography (CT) scan reveals well-defined rounded splenic and hepatic nodules without enhancement.

(A) Axial section in the injected abdominal CT scan displays a rounded, well-limited, and not enhanced hepatic nodule in segment IV (arrow). (B) Axial slice in the injected abdominal CT scan depicts well-defined, rounded splenic nodules without enhancement (arrow).

Figure 3. Esophagogastroduodenoscopy shows centimeter-sized, round reddish lesions with a slightly purplish hue.

(A) The gastric body is displaying several centimeter-sized nummular reddish lesions, slightly purplish, and infiltrative. (B) The duodenal mucosa is displaying several centimeter-sized nummular reddish lesions, slightly purplish, and infiltrative.

Figure 4. Colonoscopy shows scattered polypoid reddish centimeter-sized elevated round lesions, diffusely distributed over the entire colonic mucosa.