P1790 - Visceral Kaposi Sarcoma of the Liver and Stomach Without Cutaneous Involvement in a Patient with HIV/AIDS

Edward Zongci. Cao, BS, BA¹, Mena Saad, DO², Jeremy Deisch, MD², Melissa Pereira, BS², Yousef Fakhouri, BS², Made Sutjita, MD²
1University of California Riverside School of Medicine, Rancho Cucamonga, CA; 2Riverside University Health System, Moreno Valley, CA

Introduction: Kaposi sarcoma (KS) is a rare angioproliferative neoplasm caused by human herpesvirus-8 (HHV-8), most commonly affecting immunocompromised individuals, particularly those with HIV/AIDS. While KS typically presents with cutaneous lesions, visceral involvement—especially of the gastrointestinal and hepatic systems—is less common and often asymptomatic. Isolated hepatic and gastric involvement without skin manifestations is particularly rare. We present an unusual case of AIDS-related KS with hepatic and gastric involvement in the absence of cutaneous disease in a 25-year-old male with poorly controlled HIV.

Case Description/

Methods: A 25-year-old male with a history of HIV, non-adherent to antiretroviral therapy (ART), presented with a two-year history of progressive dysphagia to solids and liquids, and a one-week history of nausea, vomiting, and nonbloody diarrhea.

Physical exam was negative for violaceous or nodular lesions. HIV RNA viral load was 153,000 copies/mL, and CD4 count was < 20 cells/µL. HIV genotyping demonstrated infection with HIV-1 subtype B with E138A mutation. CT imaging of the abdomen revealed numerous heterogeneous hepatic masses, the largest measuring 7.8 × 4 cm (Figure 1).

Esophagogastroduodenoscopy (EGD) showed Los Angeles Grade D esophagitis with a distal esophageal stricture (Figure 2). Balloon dilation (8-9-10 mm) was performed (Figure 3). An 8-mm clean-based ulcer (Forrest Class III) was identified along the greater curvature of the stomach and biopsied (Figure 4).

An ultrasound-guided liver biopsy was performed (Figure 5). Pathology demonstrated partial effacement of liver tissue by an atypical vascular proliferation (Figure 6). Immunohistochemistry performed on the biopsy showed expression of vascular markers (CD34, ERG1) and HHV8 latency associated nuclear antigen (LANA), confirming hepatic KS (Figure 7). A subsequent biopsy was performed on the gastric ulcer, showing an atypical spindled vascular proliferation (Figure 8) that stained positive for CD31 and HHV8 LANA (Figure 9), confirming gastric KS.

Discussion: Visceral KS without skin lesions is rare. Gastrointestinal and hepatic KS may present with dysphagia, abdominal pain, diarrhea, or be entirely asymptomatic. Our patient’s presentation underscores the importance of maintaining a high index of suspicion for visceral KS in immunocompromised patients, even in the absence of classic skin lesions. Early recognition and prompt initiation of ART and systemic chemotherapy are critical for improving outcomes.


Figure: Figure 1: CT abdomen reveals numerous heterogeneous hepatic masses, the largest measuring 7.8 × 4 cm
Figure 2: Esophagogastroduodenoscopy (EGD) shows Los Angeles Grade D esophagitis with a distal esophageal stricture
Figure 3: Esophageal stricture was dilated with balloon dilation (8-9-10 mm)
Figure 4: Esophagogastroduodenoscopy (EGD) reveals an 8-mm clean-based ulcer (Forrest Class III) along the greater curvature of the stomach


Figure: Figure 5: Ultrasound-guided liver biopsy was performed
Figure 6: Liver biopsy shows effacement of the liver parenchyma by an atypical spindled vascular proliferation (arrow) (hematoxylin and eosin stain, 400X magnification)
Figure 7: Tumor cells in liver biopsy express CD34 (left), ERG1 (middle), and HHV8 LANA (right) by immunohistochemistry (400X magnification)
Figure 8: Atypical spindled vascular proliferation (arrow) present amongst unremarkable gastric glands (hematoxylin and eosin stain, 400X magnification)
Figure 9: Tumor cells in gastric biopsy express vascular marker CD31 (left) and HHV8 LANA (right) (CD31 400X magnification, HHV8 LANA 100X magnification)

Disclosures:
Edward Cao indicated no relevant financial relationships.
Mena Saad indicated no relevant financial relationships.
Jeremy Deisch indicated no relevant financial relationships.
Melissa Pereira indicated no relevant financial relationships.
Yousef Fakhouri indicated no relevant financial relationships.
Made Sutjita indicated no relevant financial relationships.

Edward Zongci. Cao, BS, BA¹, Mena Saad, DO², Jeremy Deisch, MD², Melissa Pereira, BS², Yousef Fakhouri, BS², Made Sutjita, MD². P1790 - Visceral Kaposi Sarcoma of the Liver and Stomach Without Cutaneous Involvement in a Patient with HIV/AIDS, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.