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Asymptomatic appendiceal Kaposi sarcoma and its relation with HIV, Fournier gangrene and COVID 19
Kaposi Sarcoma (KS) has a high incidence rate in HIV-positive patients. It is a mesenchymal tumor marked by the presence of violaceous plaques in the lower limbs. It may spread to target organs, becoming aggressive and presenting unusual clinical signs.
Male, 50 years-old, untreated HIV for 5 years (CD4 = 214) and diabetic. Admitted to the emergency room with fever, pain, perianal bulging and purulent drainage. The diagnostic of Fournier gangrene was made and immediate surgical debridement was performed. Computed tomography (CT) of pelvis showed, as an incidental finding, signs of acute appendicitis, which was absolutely incompatible with the initial clinical presentation.
Due to the lesion’s proximity to the anus, which impaired hygiene and healing, a video laparoscopic colostomy was indicated. During the procedure, purulent fluid was observed in the abdominal cavity and an inflammatory process in the appendix (acute appendicitis grade 2) was observed, matching CT scan findings. Appendectomy was performed and anatomopathological study, revealing Kaposi's Sarcoma.
During hospitalization the patient evolved with severe COVID-19 infection, requiring intubation and mechanical ventilation. Also, developed acute renal insufficiency, ultimately dying from complications of Sars-CoV-2 before the KS could be followed-up.
KS is the most frequent tumor in patients with Acquired Immunodeficiency Syndrome (AIDS), most commonly involving cutaneous tissue. Gastrointestinal KS occurs in 40% of patients, mainly in stomach, duodenum, and biliary tract. On the other hand, jejunum, ileum and large intestine have a low incidence rate.
HIV-positive patients are four times more likely to have acute appendicitis than the general population. However, despite being the most prevalent malignant gastrointestinal tumor in patients with AIDS, the involvement of the appendix is rare and hardly ever reported in the literature..
Treatment depends on the sarcoma variant and the affected site. Treatment of HIV and improving immunological status is the keystone in this context.
This is a rare combination of factors striking an HIV/AIDS patient, in which KS with unusual presentation, allied with Fournier´s and COVID infection, deeply contributed to undermine patient´s last defenses. All diseases feast in a deprived immunological system; special attention must be paid in these times of worldwide pandemic.
Kaposi sarcoma, Fournier gangrene, Sars-CoV-2
Sarcomas / tumores ósseos*
WILLIAM AUGUSTO CASTELEINS, CARLA CENI, ANTONIO PACHECO ILGENFRITZ, PHILIPPE VALASKI, RAQUEL RODRIGUES MARTINS, EDUARDO DE AGUIAR BUERGER, LARISSA LUVISON GOMES DA SILVA