Kaposi Sarcoma of the Ampulla of Vater and AIDS Cholangiopathy: A Rare Biliary Presentation

Biliary manifestations in advanced acquired immunodeficiency syndrome (AIDS) present unique diagnostic challenges. We present a case of Kaposi sarcoma of the ampulla of Vater with AIDS cholangiopathy in a 25-year-old man. He presented with watery nonbloody diarrhea and loss of weight for 2 months with a cholestatic liver pattern. Magnetic resonance cholangiopancreatography showed hepatic lesions possibly Kaposi sarcoma and irregular bile and pancreatic ducts with a suspected stricture at the ampulla consistent with AIDS cholangiopathy. Endoscopic retrograde cholangiopancreatography confirmed a vascular, umbilicated lesion in the ampulla of Vater, which proved biliary stenting difficult. This case highlights the diagnostic complexity of these rare presentations of HIV.