Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2019; 7(19): 3090-3097
Published online Oct 6, 2019. doi: 10.12998/wjcc.v7.i19.3090
Kaposi’s sarcoma manifested as lower gastrointestinal bleeding in a HIV/HBV-co-infected liver cirrhosis patient: A case report
Qi-Hui Zhou, Yong-Zheng Guo, Xia-Hong Dai, Biao Zhu
Qi-Hui Zhou, Yong-Zheng Guo, Xia-Hong Dai, Biao Zhu, The Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
Author contributions: Zhou QH reviewed the literature and contributed to manuscript drafting; Guo YZ and Dai XH performed infectious diseases consultation, analysed and interpreted imaging findings; Zhu B was responsible for the revision of the manuscript for important intellectual content; All authors issued final approval for the version to be submitted.
Supported by Chinese National Special Research Program for Important Infectious Diseases, No. 2017ZX10202102-002-002; National Science and Technology Major Project, No. 2018ZX10715-014-004.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Biao Zhu, PhD, Professor, Chief Physician, The Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Shangcheng District, Hangzhou 310000, Zhejiang Province, China. zhubiao1207@zju.edu.cn
Telephone: +86-571-87236437 Fax: +86-571-87236755
Received: March 25, 2019
Peer-review started: March 26, 2019
First decision: July 30, 2019
Revised: August 6, 2019
Accepted: August 25, 2019
Article in press: August 25, 2019
Published online: October 6, 2019
Abstract
BACKGROUND

Kaposi’s sarcoma (KS) is one of the most common cancers in human immunodeficiency virus (HIV)-positive patients and leads to a high prevalence of morbidity and mortality. It usually appears as cutaneous or mucous lesions. Patients with visceral KS are asymptomatic and clinically silent. As the disease advances, patients may progress from a normal condition to exhibiting severe symptoms.

CASE SUMMARY

A 27-year-old man presented with a 2-mo history of fever, bearing-down pain, and rectal bleeding. His hepatitis B virus DNA level was 2.7 ×107 IU/mL. Abdominal computed tomography (CT) indicated liver cirrhosis. Before he was admitted to our hospital, he was diagnosed with HIV infection. His CD4 count was 24 cells/μL. Pelvic cavity CT suggested a thickened rectum wall accompanied by multiple enlarged lymph nodes. The patient was initially treated as having haemorrhoidal varices with bleeding, telbivudine for anti-hepatitis B virus treatment, and antibiotics for anti-infection. After half a month of treatment, the patient felt that his lower lumbus ache and bearing-down pain had not improved, and a colonoscopy was conducted. The result revealed a rectal mass that was histologically confirmed as KS with rectal spindle cells that were positive for cluster of differentiation 117 (CD117), CD34, human herpes virus 8, and CD31. He was administered systemic chemotherapy with 36 mg/d liposomal doxorubicin six times. The patient experienced no sign of lower gastrointestinal bleeding again.

CONCLUSION

This case highlights the diagnosis of primary KS with lower gastrointestinal bleeding in HIV-positive patients, which means visceral KS could not be excluded. The gold standard relies on colonoscopy and biopsy findings.

Keywords: Human immunodeficiency virus/hepatitis B virus co-infection, Kaposi’s Sarcoma, Lower gastrointestinal bleeding, Colonoscopy, Immunohistochemistry, Case report

Core tip: Human immunodeficiency virus (HIV)-related Kaposi’s sarcoma (KS) is the most common malignancy affecting HIV-positive patients. It usually appears as cutaneous or mucous lesions; however, KS in the viscera cannot be excluded. Patients may progress from a normal condition to exhibiting severe symptoms. We present herein, a rare case of HIV/hepatitis B virus co-infection that manifested as fever, bearing-down pain, and rectal bleeding. This case highlights that primary KS without a cutaneous manifestation should not be ignored when physicians make infectious consultation. Emphasis should be placed on colonoscopy and biopsies.