Non-cutaneous AIDS-associated Kaposi's sarcoma presenting as recurrent rectal abscesses

Disseminated AIDS-associated Kaposi sarcoma without cutaneous involvement: a case report and review of literature

Disseminated AIDS-associated Kaposi sarcoma (KS) without cutaneous lesions is rare and can present in varying ways. Diagnosis is even more challenging now when incidence of KS is on the decline. A high index of suspicion is required for early diagnosis and treatment. Therefore, the medical literature should be made aware of any manifestations of KS that can occur without the typical cutaneous lesions. A 23-year-old presented with worsening cervical lymphadenopathy, recurrent cough and bilateral leg swelling of a month duration. Examination revealed features of pericardial effusion, pulmonary fibrosis, necrotizing cervical lymphadenopathy and the presence of pityriasis rotunda at the periumbilical region. Patient was diagnosed human immunodeficiency virus (HIV) positive 6 months before she presented and was placed on antiretroviral therapy. Histology confirmed AIDS-associated KS. However, patient died before commencement of chemotherapy. The clinical course of disseminated AIDS-associated KS without cutaneous lesions can be atypical and aggressive. It is important to include KS in the differential diagnosis of cases with atypical or persistence/recurrence of clinical symptoms in spite of treatment especially in HIV patients.

A Retrospective Study of the Presentation and Management of Perianal Disease in HIV-Positive Patients Referred to a Surgical Outpatient Unit in Turkey

BACKGROUND The incidence of human immunodeficiency virus (HIV) infection is on the rise, and perianal region diseases in HIV-infected patients have become increasingly prevalent. This study aimed to analyze the surgical treatment outcomes of HIV-infected patients presenting with perianal concerns. MATERIAL AND METHODS We included 311 HIV-positive patients admitted to the Infectious Diseases Clinic of Samsun Training and Research Hospital between January 2014 and December 2022. From this group, we selected those who sought care at the general surgery outpatient clinic for perianal and anal concerns, retrospectively reviewing their medical records. RESULTS Out of 311 patients, 54 (17.3%) were referred to the general surgery outpatient clinic with anal and/or perianal region complaints. Of these cases, 38 (70.3%) had a single disease, while 16 (29.6%) had combined diseases. There were 20 males (95%) and 1 female (5%). Among these 54 patients, 33 (61.1%) received medical treatment from the outpatient clinic, while 21 (38.9%) underwent surgical intervention. The diagnoses included 22 hemorrhoidal diseases, 24 anal condylomas, 15 anal fissures, 11 anal abscesses, and 4 anal fistulas. We evaluated the postoperative results and recurrence status of these patients. CONCLUSIONS Perianal diseases in HIV-positive patients can be categorized as isolated or combined. The management of patients with postoperative follow-up compliance problems and combined diseases with low CD4 counts may pose treatment challenges.

Non-Cutaneous Visceral Kaposi's Sarcoma Diagnosis Confounded by Mycobacterium Avium Complex Lymphadenitis

Kaposi's sarcoma (KS) is an Acquired Immune Deficiency Syndrome (AIDS)-defining illness, with cutaneous KS being a more common presentation. Visceral involvement, particularly in the gastrointestinal (GI) tract, without cutaneous involvement, is rare. Consisting of generally non-specific symptoms, GI-KS can have potentially fatal outcomes, including hemorrhage or perforation, making prompt diagnosis and treatment imperative. Our case describes a 31-year-old male with AIDS who presented with a neck mass and purulent, bloody rectal drainage. The neck mass was biopsied and identified as caseated necrotic cervical lymphadenitis caused by Mycobacterium avium complex (MAC). The patient presented with rectal drainage, and additional abdominal necrotic lymph nodes were discovered on CT. A subsequent colonoscopy was completed, confirming the diagnosis of visceral KS. Delayed diagnosis of visceral KS can lead to an extensive, widespread disease requiring adjuvant and prolonged treatment. Prompt diagnosis can reduce morbidity and mortality. This case aims to shed light on a rare presentation of a common disease state with potentially fatal complications and emphasizes the importance of maintaining a broad differential diagnosis.

Anorectal pathology in the HIV population: a guide for radiologists

Patients with human immunodeficiency virus (HIV) can present with a wide range of different acute and chronic pathologies. Anorectal conditions are particularly common in this unique patient population, including pathologies, such as proctitis, anorectal abscess, anorectal fistula, and anal squamous cell carcinoma. The radiologist plays a critical role in the assessment of these common forms of anorectal disease, as these conditions can present with various findings on imaging assessment. Pelvic CT, MRI, and FDG-PET/CT are among the most common modalities used for assessment of anorectal disease in the HIV patient population. Knowledge of the fundamental clinical and imaging findings associated with these pathologies in HIV patients is critical for radiologists.