Iatrogenic Kaposi sarcoma of the terminal ileum following short-term treatment with immunomodulators for Crohn disease

A case report

Research output: Contribution to journalArticle

Abstract

RATIONALE: Kaposi sarcoma (KS) is a mesenchymal neoplasm associated with human herpes virus-8. It is often found in patients with primary or secondary immunodeficiency. An iatrogenic form of KS is detectable in patients who have received immunosuppressive therapy. To date, there are few reported cases of patients with KS treated with immunosuppressants for inflammatory bowel disease.

PATIENT CONCERNS: We report the case of a 45-year-old young woman with abdominal pain, episodic diarrhea and a mild weight loss. The patient was treated with immunosuppressive therapy for a parietal thickening of the terminal ileum, wrongly diagnosed as Crohn disease. After 9 months after the beginning of antitumor necrosis factor-α, the patient was admitted for obstructive symptoms. A computed tomography suspected neoplasia of ileocecal region. The patient underwent an uneventful ileocecal surgical resection.

DIAGNOSES: The histopathology showed endometriosis of the ileal wall and an irrefutable diagnosis of KS by immunohistochemistry-positive staining for human herpes virus-8.

INTERVENTIONS AND OUTCOMES: The patient underwent surgical resection and is disease free at 6 years follow-up.

LESSONS: This case underlines the interaction of immunosuppressive therapy with the possible consequent development of visceral KS.

Original languageEnglish
Pages (from-to)e15714
JournalMedicine
Volume98
Issue number20
DOIs
Publication statusPublished - May 2019

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Kaposi's Sarcoma
Immunologic Factors
Ileum
Crohn Disease
Immunosuppressive Agents
Therapeutics
Viruses
Endometriosis
Inflammatory Bowel Diseases
Abdominal Pain
Weight Loss
Diarrhea
Neoplasms
Necrosis
Immunohistochemistry
Tomography
Staining and Labeling

Keywords

  • Crohn Disease/drug therapy
  • Diagnostic Errors
  • Digestive System Surgical Procedures
  • Female
  • Humans
  • Iatrogenic Disease
  • Ileal Neoplasms/diagnostic imaging
  • Immunosuppressive Agents/adverse effects
  • Intestinal Obstruction/chemically induced
  • Middle Aged
  • Sarcoma, Kaposi/diagnostic imaging
  • Treatment Outcome

Cite this

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title = "Iatrogenic Kaposi sarcoma of the terminal ileum following short-term treatment with immunomodulators for Crohn disease: A case report",
abstract = "RATIONALE: Kaposi sarcoma (KS) is a mesenchymal neoplasm associated with human herpes virus-8. It is often found in patients with primary or secondary immunodeficiency. An iatrogenic form of KS is detectable in patients who have received immunosuppressive therapy. To date, there are few reported cases of patients with KS treated with immunosuppressants for inflammatory bowel disease.PATIENT CONCERNS: We report the case of a 45-year-old young woman with abdominal pain, episodic diarrhea and a mild weight loss. The patient was treated with immunosuppressive therapy for a parietal thickening of the terminal ileum, wrongly diagnosed as Crohn disease. After 9 months after the beginning of antitumor necrosis factor-α, the patient was admitted for obstructive symptoms. A computed tomography suspected neoplasia of ileocecal region. The patient underwent an uneventful ileocecal surgical resection.DIAGNOSES: The histopathology showed endometriosis of the ileal wall and an irrefutable diagnosis of KS by immunohistochemistry-positive staining for human herpes virus-8.INTERVENTIONS AND OUTCOMES: The patient underwent surgical resection and is disease free at 6 years follow-up.LESSONS: This case underlines the interaction of immunosuppressive therapy with the possible consequent development of visceral KS.",
keywords = "Crohn Disease/drug therapy, Diagnostic Errors, Digestive System Surgical Procedures, Female, Humans, Iatrogenic Disease, Ileal Neoplasms/diagnostic imaging, Immunosuppressive Agents/adverse effects, Intestinal Obstruction/chemically induced, Middle Aged, Sarcoma, Kaposi/diagnostic imaging, Treatment Outcome",
author = "Elisa Stasi and {De Santis}, Stefania and Elisabetta Cavalcanti and Raffaele Armentano",
year = "2019",
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language = "English",
volume = "98",
pages = "e15714",
journal = "Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries",
issn = "0025-7974",
publisher = "Lippincott Williams and Wilkins",
number = "20",

}

TY - JOUR

T1 - Iatrogenic Kaposi sarcoma of the terminal ileum following short-term treatment with immunomodulators for Crohn disease

T2 - A case report

AU - Stasi, Elisa

AU - De Santis, Stefania

AU - Cavalcanti, Elisabetta

AU - Armentano, Raffaele

PY - 2019/5

Y1 - 2019/5

N2 - RATIONALE: Kaposi sarcoma (KS) is a mesenchymal neoplasm associated with human herpes virus-8. It is often found in patients with primary or secondary immunodeficiency. An iatrogenic form of KS is detectable in patients who have received immunosuppressive therapy. To date, there are few reported cases of patients with KS treated with immunosuppressants for inflammatory bowel disease.PATIENT CONCERNS: We report the case of a 45-year-old young woman with abdominal pain, episodic diarrhea and a mild weight loss. The patient was treated with immunosuppressive therapy for a parietal thickening of the terminal ileum, wrongly diagnosed as Crohn disease. After 9 months after the beginning of antitumor necrosis factor-α, the patient was admitted for obstructive symptoms. A computed tomography suspected neoplasia of ileocecal region. The patient underwent an uneventful ileocecal surgical resection.DIAGNOSES: The histopathology showed endometriosis of the ileal wall and an irrefutable diagnosis of KS by immunohistochemistry-positive staining for human herpes virus-8.INTERVENTIONS AND OUTCOMES: The patient underwent surgical resection and is disease free at 6 years follow-up.LESSONS: This case underlines the interaction of immunosuppressive therapy with the possible consequent development of visceral KS.

AB - RATIONALE: Kaposi sarcoma (KS) is a mesenchymal neoplasm associated with human herpes virus-8. It is often found in patients with primary or secondary immunodeficiency. An iatrogenic form of KS is detectable in patients who have received immunosuppressive therapy. To date, there are few reported cases of patients with KS treated with immunosuppressants for inflammatory bowel disease.PATIENT CONCERNS: We report the case of a 45-year-old young woman with abdominal pain, episodic diarrhea and a mild weight loss. The patient was treated with immunosuppressive therapy for a parietal thickening of the terminal ileum, wrongly diagnosed as Crohn disease. After 9 months after the beginning of antitumor necrosis factor-α, the patient was admitted for obstructive symptoms. A computed tomography suspected neoplasia of ileocecal region. The patient underwent an uneventful ileocecal surgical resection.DIAGNOSES: The histopathology showed endometriosis of the ileal wall and an irrefutable diagnosis of KS by immunohistochemistry-positive staining for human herpes virus-8.INTERVENTIONS AND OUTCOMES: The patient underwent surgical resection and is disease free at 6 years follow-up.LESSONS: This case underlines the interaction of immunosuppressive therapy with the possible consequent development of visceral KS.

KW - Crohn Disease/drug therapy

KW - Diagnostic Errors

KW - Digestive System Surgical Procedures

KW - Female

KW - Humans

KW - Iatrogenic Disease

KW - Ileal Neoplasms/diagnostic imaging

KW - Immunosuppressive Agents/adverse effects

KW - Intestinal Obstruction/chemically induced

KW - Middle Aged

KW - Sarcoma, Kaposi/diagnostic imaging

KW - Treatment Outcome

U2 - 10.1097/MD.0000000000015714

DO - 10.1097/MD.0000000000015714

M3 - Article

VL - 98

SP - e15714

JO - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries

JF - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries

SN - 0025-7974

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ER -