Flores Córdova Estefanía, Mathew Madhu, Mutneja Hemant, Gonzalez Caldito Elena, Demetria Melchor
Internal Medicine, Cook County Health and Hospital System, Chicago, USA.
Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA.
Cureus. 2020 Jun 29;12(6):e8913. doi: 10.7759/cureus.8913.
Kaposi sarcoma is one of the acquired immunodeficiency syndrome (AIDS) defining diseases. AIDS-associated Kaposi sarcoma affects primarily the skin and the lungs. Although gastrointestinal involvement is relatively common, biliary tract involvement has rarely been reported. It has been associated mostly with extension from liver disease. We describe an uncommon presentation of disseminated Kaposi sarcoma causing extrahepatic cholestasis due to extrahepatic biliary tract involvement that resolved after sphincterotomy with biliary stenting. We present a case of a 35-year-old African American male diagnosed with human immunodeficiency virus (HIV) infection in 2005. He presented with AIDS after discontinuation of antiretroviral therapy for one year, subsequently being diagnosed with systemic Kaposi sarcoma. He presented with signs and symptoms of obstructive biliary disease, including jaundice, abdominal pain, fatigue, and fever. We encountered a rare presentation of malignant single extrahepatic biliary stenosis secondary to biliary Kaposi sarcoma. The biochemical pattern markedly improved after endoscopic retrograde cholangiopancreatography with sphincterotomy and stenting. However, and despite the resumption of combined antiretroviral therapy, deep immunosuppression caused worsening clinical condition and death five months after initial presentation. Certainly, among the multiple etiologies of biliary obstruction in AIDS, Kaposi sarcoma is one to consider.
卡波西肉瘤是获得性免疫缺陷综合征（艾滋病）的定义性疾病之一。艾滋病相关的卡波西肉瘤主要累及皮肤和肺部。尽管胃肠道受累相对常见，但胆道受累鲜有报道。它大多与肝脏疾病的蔓延有关。我们描述了一例罕见的播散性卡波西肉瘤病例，该病例因肝外胆道受累导致肝外胆汁淤积，在进行括约肌切开术并置入胆道支架后病情得到缓解。我们报告一例35岁的非裔美国男性，他于2005年被诊断为感染人类免疫缺陷病毒（HIV）。在停止抗逆转录病毒治疗一年后，他出现了艾滋病症状，随后被诊断为系统性卡波西肉瘤。他出现了阻塞性胆道疾病的体征和症状，包括黄疸、腹痛、乏力和发热。我们遇到了一例罕见的由胆道卡波西肉瘤继发的恶性肝外单发性胆管狭窄病例。在内镜逆行胰胆管造影术联合括约肌切开术和支架置入术后，生化指标明显改善。然而，尽管恢复了联合抗逆转录病毒治疗，但深度免疫抑制导致患者在初次就诊五个月后临床状况恶化并死亡。当然，在艾滋病患者胆道梗阻的多种病因中，卡波西肉瘤是需要考虑的病因之一。
