Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2017; 5(12): 423-427
Published online Dec 16, 2017. doi: 10.12998/wjcc.v5.i12.423
Human herpesvirus-8 positive iatrogenic Kaposi's sarcoma in the setting of refractory ulcerative colitis
Erica Duh, Sean Fine
Erica Duh, Warren Alpert Medical School of Brown University, Providence, RI 02903, United States
Sean Fine, Department of Inflammatory Bowel Disease, Warren Alpert Medical School, Providence, RI 02903, United States
Author contributions: Duh E drafted manuscript; Fine S collected and interpreted data, proof/read manuscript.
Institutional review board statement: Case report written with initial intention only to treat and not for research.
Informed consent statement: Verbal consent was obtained from all patients included in this submission.
Conflict-of-interest statement: The authors have no potential conflict of interest, real or perceived, and no additional disclosures.
Open-Access: This article is an open-access article which 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/
Correspondence to: Erica Duh, BS, Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, United States. erica_duh@brown.edu
Telephone: +1-301-7583862 Fax: +1-401-8635711
Received: August 24, 2017
Peer-review started: August 25, 2017
First decision: September 6, 2017
Revised: September 22, 2017
Accepted: September 28, 2017
Article in press: September 28, 2017
Published online: December 16, 2017
Processing time: 104 Days and 19.9 Hours
Abstract

Although Kaposi sarcoma (KS) has been more traditionally considered an AIDS-defining illness, it may also be seen in individuals on immunosuppresive therapy. We report a case of a patient who presented to the hospital in the setting of increasingly refractory ulcerative colitis. Computed tomography scan of the abdomen was consistent with sigmoid diverticulititis and blood cultures were positive for Klebsiella. After a course of antibiotics with resolution of infection, a colonoscopy was performed to evaluate his diverticulitis and incidentally revealed a new rectal tumor. Immunohistochemistry showed the tumor was consistent with KS, with cells staining strongly positive for human herpesvirus-8. This case not only illustrates a rare case of KS found in an HIV-negative individual, but it also highlights the importance of considering an alternative diagnosis in a patient refractory to medical treatment. We discuss the management and care of an ulcerative colitis patient diagnosed with KS on immunosuppressive therapy.

Keywords: Kaposi sarcoma; Colorectal cancer; Ulcerative colitis; Inflammatory bowel disease; HIV/AIDS; Human herpesvirus-8

Core tip: Kaposi sarcoma (KS) is associated with human herpes 8 virus infection and is typically an acquired immune deficiency syndrome defining illness. However, KS may also be seen in patients who are on long-term immunosuppression. Review of the literature suggests that isolated gastrointestinal KS is a very rare complication, as there are less than 20 reported cases in the English language literature in ulcerative colitis HIV negative host. Our findings contribute to a small body of literature illustrating the manifestation of primary gastrointestinal KS without skin manifestations in a patient with refractory colitis to medical management.