Details

Autor(en) / Beteiligte

• Jahir, Tahmina
• Bondarenko, Ekaterina Casmartino
• Malik, Faiza
• Nguyen, Matthew
• Hossain, Sm
• Jagroop, Sophia

Titel

Chronic Nasal Sinusitis Revealing Disseminated Kaposiʼs Sarcoma: 1967

Ist Teil von

• The American journal of gastroenterology, 2018-10, Vol.113 (Supplement), p.S1121-S1121

Ort / Verlag

New York: Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins

Erscheinungsjahr

2018

Beschreibungen/Notizen

• AIDS-related Kaposi sarcoma (KS) is a vascular tumor which is characterized by angiogenesis, inflammation, and cellular proliferation. KS can involve virtually any site of the body, cutaneous disease being most common. It has a propensity to involve visceral organs in the immunocompromised population. While the common sources of upper gastrointestinal bleeding are familiar to physicians, here we present a rare report of gastrointestinal bleeding with chronic nasal sinusitis attributable to this malady. A 39-year-old male with a pertinent history of AIDS on HAART therapy who presented with generalized weakness with chronic nasal congestion, sinus pressure and voice change for 1 week. Physical exam was significant for icteric skin and sclera, hepatosplenomegaly, diffuse leg swelling. Further evaluation revealed anemia, guaiac positive stools, elevated liver enzymes with a Maddrey discriminant function of 55.6. EGD showed multiple firm friable masses in the gastric antrum and body and biopsy revealed fragments of gastric mucosa with focally disrupted architecture by a spindle cell neoplasm, positive for CD31, CD34 and HHV-8, suggestive of KS. The CD4 count was 139, viral load 94,027. Nasopharyngeal scoping revealed an edematous inferior nasal turbinate with a bluish, smooth, firm, nonpulsatile mass in the nasopharyngeal wall, possibly disseminated KS. A CT scan showed moderate mucosal thickening and fluid within the right maxillary sinus with occlusion of bilateral ostiomeatal units. HAART was held due to elevated liver enzymes, MAC and PCP prophylaxis started. During the hospital course patient became septic due to MRSA bacteremia, chemotherapy was held due to underlying bacterial infection, eventually intubated, developed DIC, septic shock and expired. KS is the most common tumor arising in HIV however, such widespread presentation is quite a rare phenomenon. It is unclear as to which subtype of the KS resulted here harboring such a poor prognosis. KS is commonly associated with a condition known as IRIS (Immune reconstitution inflammatory syndrome), Our patient may have been the victim of KS-IRIS as a history of worsening symptoms after being put on HAART were noted by him. There is no officially accepted system for staging KS. Since this disease is commonly diagnosed at an advanced stage, identification of potential biomarkers to distinguish between KS IRIS and KS progression, and evaluation of optimal management strategies would be beneficial.