Gastrointestinal Kaposi sarcoma is an uncommon but clinically relevant manifestation of human herpesvirus 8-associated disease in patients with human immunodeficiency virus (HIV) infection. Its diagnosis may be delayed because symptoms are often nonspecific and may overlap with other anorectal disorders, particularly in patients with condylomatous disease, fissures, proctitis, or anal malignancy. We report the case of a 25-year-old male with HIV infection on antiretroviral therapy and an undetectable viral load who presented with one month of anal pain and rectal bleeding. Initial colonoscopy demonstrated multiple irregular ulcerated lesions in the distal rectum, and biopsy confirmed Kaposi sarcoma associated with human herpesvirus 8. Despite referral to Medical Oncology and initiation of chemotherapy, the patient had persistent rectal bleeding, mucus discharge, anal condyloma, and fissure. Repeat proctologic evaluation and colonoscopy revealed elevated, irregular, ulcerated circumferential lesions extending from the anal canal to 10 cm proximally, with increased submucosal vascular pattern. Persistent gastrointestinal Kaposi sarcoma with suspicious anorectal tumoral involvement was identified, and the patient was referred for multidisciplinary oncologic management. This case highlights the diagnostic challenge of anorectal Kaposi sarcoma in patients with HIV infection, especially when symptoms overlap with benign anorectal disease or synchronous malignancy. Early endoscopic evaluation, biopsy, and immunohistochemistry are essential for timely diagnosis and appropriate multidisciplinary treatment.
Ramírez et al. (Fri,) studied this question.