Disseminated iatrogenic upper gastrointestinal Kaposi sarcoma following prolonged steroid use in a patient with Crohn’s disease: a case report

Abstract

BACKGROUND: Kaposi sarcoma is a malignant vascular neoplasm caused by human herpesvirus-8. It is mostly seen in immunocompromised individuals, particularly those with human immunodeficiency virus/acquired immunodeficiency syndrome or organ transplants. Cutaneous and mucosal Kaposi sarcoma manifestation is common; however, Kaposi sarcoma may involve the visceral organs. Iatrogenic or drug-induced Kaposi sarcoma may develop in immunocompromised patients undergoing immunosuppressive medication. It is quite uncommon for patients with inflammatory bowel diseases on immunosuppressive medication to develop intestinal Kaposi sarcoma. This case report describes the clinical presentation of steroid-induced disseminated upper gastrointestinal Kaposi sarcoma in a patient with underlying Crohn's disease and examines the management approach, associated challenges, and clinical outcome. CASE PRESENTATION: We report a rare case of iatrogenic Kaposi sarcoma in a 39-year-old African male patient with Crohn's disease undergoing long-term corticosteroid treatment. Patient history, clinical examination, and investigations revealed mucosal Kaposi sarcoma with human herpes virus-8 positivity. This prompted discontinuation of corticosteroids with subsequent transition to infliximab a biologic agent. During the course of treatment with infliximab, the patient presented with extensive Kaposi sarcoma and was started on systemic chemotherapy with improvement. CONCLUSION: This case underscores the importance of maintaining a high index of suspicion for Kaposi sarcoma in patients on chronic immunosuppressive therapy who present with unusual skin or mucosal lesions.