Colorectal Kaposi Sarcoma in an Immunosuppressed Ulcerative Colitis Patient

Excerpt

A 49-year-old man with a long history of left-sided ulcerative colitis (UC), treated primarily with mesalamine and intermittent steroid enemas, developed recurrent flares associated with worsening bloody diarrhea. This resulted in the need for repeated courses of steroids (between 15 and 30 mg of prednisone daily) and the initiation of azathioprine. Although biologic therapy was recommended, the patient had declined this option due to concerns of possible side-effects and also refused surgical intervention. On routine surveillance colonoscopy, after almost 2 years of steroid-dependency, he was noted to have two inflammatory mass-like lesions, one in the proximal sigmoid colon and one in the distal rectum, both of which were biopsied (see Fig. 1). The biopsy results revealed spindle cell tumors with prominent capillary and slit-like vascular spaces, which tested positive on immunohistochemistry for human herpesvirus-8 (HHV-8).

…