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      Endoscopic Appearance of Oropharyngeal and Upper GI Kaposi's Sarcoma in an Immunocompromised Patient

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          Abstract

          Introduction. Kaposi's sarcoma (KS) usually manifests as a cutaneous disease but GI manifestation is often rare. It is associated with human herpes virus-8 (HHV-8) and seen in immunocompromised patients. In the USA, use of highly active antiretroviral therapy (HAART) has drastically reduced incidence of KS in HIV patients. Case Presentation. A 65-year-old male with human immunodeficiency virus (HIV) was admitted to the intensive care unit (ICU) with cardiopulmonary arrest secondary to hyperkalemia of 7.5 meq/L. Following placement of orogastric and endotracheal tube (ETT), a significant amount of blood was noticed in the ETT. Hemoglobin trended down from 9.6 mg/dL to 6.7 mg/dL over five days. Stool guaiac was positive. Esophagogastroduodenoscopy (EGD) was performed and revealed multiple large hypervascularized violaceous submucosal nodular lesions with stigmata of bleeding seen on the soft palate and pharynx and within the cricopharyngeal area close to the vocal cords. Biopsy of the soft palate lesions showed proliferation of neoplastic spindle shaped cells arranged in bundles with slit-like capillary spaces containing erythrocytes consistent with Kaposi's sarcoma. Biopsy was positive for HHV-8. Colonoscopy was unremarkable. There were no cutaneous manifestations of the disease. Conclusion. GI involvement of Kaposi's sarcoma must be considered in immunocompromised patients and can be confirmed by endoscopic methods.

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          Kaposi's sarcoma: endoscopic observations of gastric and colon involvement.

          Kaposi's sarcoma is a multisystem neoplastic disease in which skin manifestations are usually seen first. Visceral involvement is frequent and the gastrointestinal tract is the most common location. We report a patient with Kaposi's sarcoma in whom the typical violaceous skin lesions were the sarcoma in whom the typical violaceous skin lesions were the only overt clinical manifestations, but the patient had multiple macular angiodysplastic-like lesions on colonoscopy. In contrast to the uniform appearance of the colonic lesions, polypoid, volcano, and maculopapular lesions were seen in the stomach on endoscopy. This report provides probably the first endoscopic description of the colonic lesions of Kaposi's sarcoma and contrasts them with the typical upper gastrointestinal lesions. A thorough gastrointestinal survey should be performed in all patients with Kaposi's sarcoma to delineate involvement, since appropriate treatment will be dictated by the presence or absence of visceral involvement.
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            Epidemiologic aspects of american Kaposi's sarcoma.

            In our series of 37 patients with Kaposi's sarcoma, a larger than expected incidence of Americans of Italian and Jewish lineage was found, with 51% of Italian and 38% of Jewish background. Although a predominance of these two groups has been clearly shown previously, this may be the highest percentage of any series. In addition, 12, or 32%, of the patients were found to have concurrent diabetes mellitus. This association has been observed previously, but is not generally appreciated.
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              Kaposiʼs Sarcoma

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                Author and article information

                Journal
                Case Rep Gastrointest Med
                Case Rep Gastrointest Med
                CRIGM
                Case Reports in Gastrointestinal Medicine
                Hindawi Publishing Corporation
                2090-6528
                2090-6536
                2017
                5 February 2017
                : 2017
                : 3742684
                Affiliations
                University of Toledo Medical Center, Toledo, OH, USA
                Author notes

                Academic Editor: Yoshihiro Moriwaki

                Author information
                http://orcid.org/0000-0002-1487-2286
                http://orcid.org/0000-0002-5755-9388
                Article
                10.1155/2017/3742684
                5316429
                28261507
                a748059c-04c5-47a5-bff1-b50542a7f4c8
                Copyright © 2017 Umar Darr et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 26 October 2016
                : 9 January 2017
                Categories
                Case Report

                Gastroenterology & Hepatology
                Gastroenterology & Hepatology

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