University of Texas Rio Grande Valley at Doctors Hospital at Renaissance Mission, Texas
Juan Castano, MD1, Lyla Saeed, MD2, Martha Solis, MD2, Ans Albustamy, MD3, Carlos Cardenas, MD4 1University of Texas Rio Grande Valley at Doctors Hospital at Renaissance, Mission, TX; 2UTRGV, McAllen, TX; 3DHR, McAllen, TX; 4DHR Health, Edinburg, TX
Introduction: Kaposi sarcoma is the most common malignancy in patients with AIDS (acquired immunodeficiency syndrome)occurring at a rate of about 6 cases per million people each year. CMV (cytomegalovirus) colitis typically occurs in about 5% of patients with AIDS. Although persons with AIDS have increased risk of both diseases, concurrent disease has rarely been described. We present a case of concurrent CMV colitis and gastric Kaposi sarcoma in a patient with AIDS presenting with chronic watery diarrhea.
Case Description/Methods: A 51-year-old man with recently diagnosed AIDS and a CD4 cell count of 44 on antiretroviral therapy, presented with weakness and watery diarrhea of several weeks duration. He had a recent hospitalization for severe dehydration and acute kidney injury due to norovirus-related enteritis. He denied recent travel or antibiotic use. Significant labs on admission included creatinine 3.6 mg/dL, sodium 128 mmol/L, TSH 1 uIU/mL, fecal calprotectin 69, and CRP 11.3 mg/dL. Comprehensive gastrointestinal stool pathogen panel was negative except for norovirus. Colonoscopy demonstrated erythema, edema, and diffuse scattered ulcerations from cecum to rectum with pathology showing CMV inclusions confirming CMV colitis. EGD showed multiple violaceous gastric body polyps, some of which were removed via cold snare, with pathology demonstrating Kaposi sarcoma. Patient improved significantly with intravenous ganciclovir and was followed-up outpatient by oncology for the treatment of Kaposi sarcoma.
Discussion: AIDS is the final stage of HIV infection and confers increased risk of opportunistic diseases due to immunosuppression, especially in the setting of low CD4 count. CMV colitis risk is higher when CD4 count is less than 50 and Kaposi sarcoma risk is higher when CD4 count is less than 100. As both Kaposi sarcoma and CMV colitis can similarly present with chronic diarrhea, a high index of clinical suspicion is crucial. To date, only two cases of concurrent CMV disease with Kaposi sarcoma have been described. However, to our knowledge this the first reported case of concurrent Kaposi sarcoma involving the stomach and CMV colitis. High clinical suspicion and early detection are critical in the treatment of both disease processes in patients with AIDS.
Figure: A. EGD demonstrating gastric body violaceous nodule. B & C. Colonoscopy demonstrating multiple scattered irregular ulcerations with edema and erythema.
Juan Castano indicated no relevant financial relationships.
Lyla Saeed indicated no relevant financial relationships.
Martha Solis indicated no relevant financial relationships.
Ans Albustamy indicated no relevant financial relationships.
Carlos Cardenas indicated no relevant financial relationships.
Juan Castano, MD1, Lyla Saeed, MD2, Martha Solis, MD2, Ans Albustamy, MD3, Carlos Cardenas, MD4. P3141 - Concurrent CMV Colitis and Gastric Kaposi Sarcoma in AIDS Patient Presenting as Watery Diarrhea, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.