Steven Schulberg, DO, Kevin Bain, DO, Josef Shehebar, MD. NYU Langone Hospital – Brooklyn
Introduction: Kaposi’s sarcoma is a fatal disease that typically presents with cutaneous manifestations in immunocompromised individuals. There are a small number of documented cases where patients diagnosed with this disease present without cutaneous lesions.
Case Presentation: 35 year-old male presented with two weeks of left buttock pain. A CT scan confirmed a 1.8 cm perianal abscess with linear stranding in the left ischioanal fossa concerning for perianal fistula. The patient was taken to the OR for drainage. Flexible sigmoidoscopy revealed rectal ulcers, with biopsies taken. The patient was discharged home on antibiotics.
The patient returned with increasing pain. Physical exam revealed a new area of fluctuance, and the patient was taken back to the OR. A large abscess was encountered with a new perirectal tract. Copious pus was expressed and a seton was placed. Postoperatively the patient was treated with IV antibiotics. Increasing purulent drainage prompted re-exploration, and a new supragluteal abscess was discovered and drained.
This unusual recurrence prompted workup for an underlying immunocompromised state. HIV testing was positive, with a CD4 count of 14. The patient was started on HAART therapy. Pathology from the rectal biopsies returned confirming Kaposi Sarcoma (KS). Metastatic workup revealed pulmonary and hepatic lesions. The patient adamantly refused chemotherapy and was subsequently lost to follow up.
Discussion: KS is an aggressive tumor that classically presents with cutaneous manifestations. Mild forms can present with involvement of lymph nodes, and lesions in skin and oropharyngeal mucosa. The multicentric nature of the tumor can result in a severe progression involving visceral organs, often including the pulmonary and gastrointestinal systems.
The prevalence of KS in AIDS patients was 20,000 times that of immunocompetent individuals in the 1980s. HAART therapy allowed the incidence of KS in AIDS patients to decrease from approximately 14% to around 2% by the early 2000s. AIDS-associated KS accounts for an estimated 94% of all reported cases. Low CD4 counts in immunocompromised individuals increases the likelihood of disease onset.
The ability of KS to metastasize proves to be fatal without prompt initiation of treatment. KS presenting without cutaneous lesions is an uncommon occurrence, and can prove problematic and delay diagnosis.
Conclusion: Prompt diagnosis of Kaposi’s sarcoma and initiation of treatment is vital to decrease disease progression. A high index of suspicion should be present in immunocompromised patients, and clinicians must recognize atypical presentations in order to improve long term survival.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 91983
Program Number: P339
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster