Richard Denicola, MD
Philadelphia, Pennsylvania
Monjur Ahmed, MD, Richard Denicola, MD
Thomas Jefferson University Hospital, Philadelphia, PA
Introduction: Gastric Kaposi’s sarcoma (KS) is rare and mostly seen in patients with acquired immunodeficiency syndrome (AIDS). We present here a case of gastric KS presenting as upper gastrointestinal bleeding in a human immunodeficiency virus (HIV) negative patient with aplastic anemia.
Case Description/Methods: A 70 year old African American male was admitted with the history of hematemesis. He had sudden onset of nausea and vomiting of blood. He denied any abdominal pain or melena. He was not taking any non-steroidal anti-inflammatory drug. He was known to have aplastic anemia, diabetes mellitus, hypertension gastroesophageal reflux disease and renal insufficiency. He was undergoing treatment with cyclosporine, prednisone and anti-thymocyte globulin for his aplastic anemia. His other medications included insulin glargine, duluglutide, amlodipine, hydrochlorothiazide famotidine, prochlorperazine, valacyclovir and eltrombopag. On admission, his pulse was 125/minute and blood pressure 85/60 mm Hg which returned to normal range with infusion of 1 liter of normal saline. He looked anxious. Abdominal examination was significant for mild epigastric tenderness to palpation. Rectal examination showed heme positive stool. Remainder of the examination was normal, including no new rashes or skin lesions. Laboratory values were significant for hemoglobin of 7.8 g/dl (baseline 8.0-9.0 g/dl), white count of 4,300/cmm and platelets of 89,000/cmm in keeping with known aplastic anemia. Patient had upper endoscopy which revealed 4 cratered sub-centimeter non-bleeding ulcers with rolled edges in the gastric body (figure 1 and figure 2). The edges of the ulcers appeared to have increased vascularity. Biopsies were taken from the ulcer edges. Biopsies showed atypical mucosal spindle cell proliferation (figure 3) with positive staining for D2-40 (endothelial cell) and human herpesvirus 8 (HHV–8) confirming the diagnosis of gastric KS.
Discussion: KS is a low-grade angiolymphoproliferative tumor arising from the endothelial cells lining the blood vessels or lymphatic vessels. It can develop in patients with significant immunosuppression irrespective of HIV status. Physicians should consider gastric KS in the differential diagnoses when patients with aplastic anemia on immunosuppressive medications present with upper gastrointestinal bleed and endoscopy shows gastric ulcers. Biopsy of the gastric ulcers in this situation is essential to establish the diagnosis.
Citation: Monjur Ahmed, MD, Richard Denicola, MD. P2238 - GASTRIC KAPOSI'S SARCOMA IN A PATIENT WITH APLASTIC ANEMIA. Program No. P2238. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.