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After starting antiretroviral therapy, he returned three weeks later with fever and respiratory symptoms; oral violaceous lesions were diagnosed as Kaposi sarcoma. Imaging suggested pulmonary involvement, while colonoscopy identified a distal rectal polypoid lesion confirmed by histopathology and human herpesvirus 8 positivity. Despite the extensive visceral disease appearing after ART, clinical stability supported outpatient surveillance. The case highlights likely KS-associated immune reconstitution inflammatory syndrome.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/atypical-presentation-of-kaposi-sarcoma-case-report-endoscopy-findings-and-ks-iris/459870/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/atypical-presentation-of-kaposi-sarcoma-case-report-endoscopy-findings-and-ks-iris/459870.png","ImageObject",300,407,{"name":92,"@type":93},"Adam","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-10","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":19},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What triggered the suspicion of Kaposi sarcoma in this patient?","Question",{"text":112,"@type":113},"Oral violaceous lesions were diagnosed as Kaposi sarcoma after the patient returned with fever and respiratory symptoms shortly after starting antiretroviral therapy.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was gastrointestinal Kaposi sarcoma confirmed?",{"text":117,"@type":113},"Colonoscopy revealed a distal rectal polypoid lesion, and histopathology confirmed vascular proliferation with human herpesvirus 8 positivity consistent with KS.",{"name":119,"@type":110,"acceptedAnswer":120},"Why was continued outpatient follow-up chosen instead of immediate escalation?",{"text":121,"@type":113},"The patient remained clinically stable, with viral load reduction and CD4 count improvement, so outpatient surveillance was adopted.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},459870,1790757130,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":19,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":129,"read_time":24,"preview_page_count":4},1374404737137,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","ACG CASE REPORTS JOURNAL  \nIMAGE | ENDOSCOPY  \nAtypical Presentation of Kaposi Sarcoma  \nAndreia Guimar~aes, MD 1 , Raquel Azevedo, MD2 , Sara Lopes, MD2 , and Jo~ao Soares, MD 1  \n1 Gastrenterology Department, Unidade Local de Sau´ de de Braga, Braga, Portugal 2Infectious Diseases Department, Unidade Local de Sau´ de de Braga, Braga, Portugal  \n| CASE REPORT\u003Cbr>A 38-year-old man was admitted with Pneumocystis jirovecii pneumonia and newly diagnosed AIDS. Seven months earlier, he had surgery for perianal abscess and fistula. At admission, CD41 count was 12/mL and HIV viral load 70,700 copies/mL. He received cotrimoxazole and started antiretroviral therapy (ART) (bictegravir/emtricitabine/tenofovir alafenamide). Three weeks later, he returned with fever and respiratory symptoms. Oral violaceous lesions were diagnosed as Kaposi sarcoma (KS). Chest computed tomography showed new mediastinal and retroperitoneal lymphadenopathy and irregular pulmonary consolidations with groundglass halo, suggestive of pulmonary KS. Colonoscopy revealed a distal rectal lesion (Figure 1), with histopathology confirming vascular proliferation and human herpesvirus 8 positivity, consistent with KS. No cutaneous lesions were observed. Given clinical stability, viral load reduction (39 copies/mL), and CD4 count improvement (56/mL), outpatient follow-up and surveillance were adopted.\u003Cbr>KS is a vascular neoplasm caused by human herpesvirus 8, typically occurring in immunodeficiency states.1,2 Although KS classically presents as a cutaneous disease, it can involve virtually any visceral organ, posing significant diagnostic challenges for clinicians.3,4 Gastrointestinal involvement is notably more common in patients without cutaneous lesions compared with those with skin manifestations.2,3 However, most patients with gastrointestinal KS are asymptomatic or present with nonspecific symptoms, and the diagnosis is often made incidentally during endoscopy or at autopsy.\u003Cbr>In the present case, extensive visceral KS involvement developed after initiation of ART, likely representing KS-associated immune reconstitution inflammatory syndrome (KS-IRIS).5 Although rare, KS-IRIS is a serious complication in severely immunosuppressed patients. No standardized recommendations exist for its diagnosis or management; however, continuation of ART is generally advised.\u003Cbr>\u003Cbr>Figure 1. Endoscopic image in retroflexion view of a 20 mm polypoid lesion with a violaceous appearance in the distal rectum. |\n| --- |\n| ACG Case Rep J 2026;13:e01963 . doi:10 . 14309/crj.0000000000001963. Published online: January 8, 2026 Correspondence: Andreia Guimar~aes, MD ([andreiaguimaraes32@gmail.com](andreiaguimaraes32@gmail.com)) . |\n\nACG Case Reports [Journal / Volume 13 acgcasereports.com 1](Journal / Volume 13 acgcasereports.com 1)  \nGuimar~aes et al Atypical Presentation of Kaposi Sarcoma  \nDISCLOSURES  \nAuthor contributions: A. Guimares conceived and designed the study (conceptualization, methodology) . R. Azevedo; S. Lopes and J. Soares contributed to the critical review of the manuscript (writing—review & editing) . All authors read and approved the final version of the manuscript.  \nFinancial disclosure: None to report.  \nInformed consent was obtained for this case report. Received October 6, 2025; Accepted December 10, 2025  \nREFERENCES  \n1. Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J (eds) . Harrison ’s Principles of Internal Medicine, 20th edn, McGraw-Hill Education: New York, NY, 2018.  \n2. Schulberg S, Al-Feghali V, Bain K, Shehebar J. Non-cutaneous AIDSassociated Kaposi’s sarcoma presenting as recurrent rectal abscesses. BMJ Case Rep. 2018;2018:bcr-2018-225749 .  \n3. Kumar A, Nautsch D. Kaposi’s sarcoma of the rectum in a homosexual male with HIV-AIDS. ACG Case Rep J. 2016;3(4):e192 .  \n4. Mbamulu V, Otokpa GA, Ukonu BA, Ibekwe P. Disseminated AIDS-associated Kaposi sarcoma without cutaneous involvement: A case report and review of literature . Int Cancer Conf J. ","cbCainyl7wm9Unru","https://ap.wps.com/l/cbCainyl7wm9Unru","pdf",176320,"English","# Case Report\n## Clinical course after ART initiation\n## Endoscopic and histopathologic diagnosis\n## Management and follow-up\n# Background and discussion","[{\"question\":\"What triggered the suspicion of Kaposi sarcoma in this patient?\",\"answer\":\"Oral violaceous lesions were diagnosed as Kaposi sarcoma after the patient returned with fever and respiratory symptoms shortly after starting antiretroviral therapy.\"},{\"question\":\"How was gastrointestinal Kaposi sarcoma confirmed?\",\"answer\":\"Colonoscopy revealed a distal rectal polypoid lesion, and histopathology confirmed vascular proliferation with human herpesvirus 8 positivity consistent with KS.\"},{\"question\":\"Why was continued outpatient follow-up chosen instead of immediate escalation?\",\"answer\":\"The patient remained clinically stable, with viral load reduction and CD4 count improvement, so outpatient surveillance was adopted.\"}]","Atypical Presentation of Kaposi Sarcoma - Case Report - Endoscopy Findings and KS-IRIS | PDF"]