Program Number: P605 Day / Time: Monday, Oct 22, 10:30 AM – 4:00 PM
Esophageal Stricture: A Rare Presentation of Kaposi SarcomaCategory: Clinical Vignettes/Case Reports Sub-Category: Esophagus
Introduction: Kaposi Sarcoma lesions in gastrointestinal tract (GIT) are commonly seen in the small intestine followed by stomach, esophagus and colon. Kaposi sarcoma (KS) in GIT are commonly asymptomatic but may cause intussusceptions, gastric outlet obstruction or massive hemorrhage. In the present era with improved HAART and CD4 lymphocyte count there has been a decrease in digestive disease in AIDS specially opportunistic pathology. We present a unusual case of Kaposi sarcoma esophageal stricture. In an extensive review of the literature the has been only 1 case reported of esophageal stenosis at GE junction due to KS diagnosed on the basis of radiology without tissue diagnosis.
Case Report: A 23 year old African American male with AIDS (CD4 count of 3), non-compliant with medication complained of dysphagia and poor oral intake. He had multiple blackish-purple raised skin lesions over the entire body. EGD was performed which showed a deep concave ulceration in esophagus 31-33 cm from incisors with high grade obstruction not allowing for passage of endoscope. Biopsy was performed from ulcer site and showed squamous epithelium with reactive changes. No ulcer was seen on the specimen sample indication no tissues from the lesion. Biopsy was performed which did not show any ulceration and was thus believed to be not from the lesion of interest. A repeat EGD revealed the presence of a 5 cms long ulcerated stricture of the distal esophagus which was balloon dilated. Biopsy samples from ulcerated stricture confirmed Kaposi sarcoma, with HHV-8 and CD31 immunostains. Ulceration with reactive epithelial changes, acute inflammation and granulation tissue was seen. Biopsy samples were negative for CMV, HSV and fungus by immunohistochemical and special stains.
Discussion: Esophageal disease in AIDS is usually associated with pathologic process. Patients presenting with esophageal complaints like dysphagia need to be evaluated for possible cause. Common causes of esophageal disease are infection by candida, CMV, HSV, KS or lymphoma. KS is one of the AIDS defining malignancies. It is more commonly seen in untreated HIV patient with low CD4 count [<200cells/mcl] and higher HIV viral load. With development of HAART there has been decrease in total number of cases of Kaposi sarcoma. Esophageal stricture due to KS is a rare presentation of the disease and needs tissue diagnosis to rule out other etiologies like CMV, candida and HSV. KS can be well controlled with HAART therapy but in case of no response or visceral involvement it is important to initiate chemotherapy. Although our patient underwent balloon dilatation, his stricture recurred within a month requiring PEG Tube placement for maintaining nutrition.
Citation: . ESOPHAGEAL STRICTURE: A RARE PRESENTATION OF KAPOSI SARCOMA. Program No. P605. ACG 2012 Annual Scientific Meeting Abstracts. Las Vegas, NV: American College of Gastroenterology.