Title : Acute pancreatitis as a rare initial manifestation of visceral Kaposi sarcoma: A case report
Abstract:
Background/Introduction: Acute pancreatitis in HIV is commonly attributed to antiretroviral therapy (ART) toxicity, CMV, or hypertriglyceridemia (HTG). Its presentation as the initial sign of advanced, uncontrolled HIV/AIDS, driven by a disseminated malignancy like visceral Kaposi sarcoma (KS), is exceedingly rare. This case highlights a challenging and rapidly fatal atypical presentation of opportunistic malignancy in a setting of late HIV diagnosis.
Case Report: We present a 28-year-old Filipino male, newly diagnosed with advanced HIV and concurrent pulmonary tuberculosis, who presented with severe epigastric pain, jaundice, and abdominal distension. He reported non-adherence to ART. Physical exam is suggestive of severe immunosuppression without skin lesions. Initial labs showed elevated amylase and lipase, profound cholestasis, and co-existing severe HTG, though the etiology was complex. Endoscopic evaluation revealed multiple, characteristic reddish polypoid lesions scattered throughout the stomach and esophagus. Endosonographic (EUS) findings included pancreatic head enlargement with hypodense lesions and peripancreatic lymphadenopathy. These combined findings were considered pathognomonic for disseminated visceral Kaposi sarcoma. Active bleeding precluded definitive tissue biopsy. Despite aggressive supportive care, the patient rapidly deteriorated into shock and multi-organ failure, succumbing to complications of advanced HIV and the widespread presumptive malignancy.
Conclusion: This case powerfully illustrates acute pancreatitis as a rare, severe, and rapidly progressive initial manifestation of uncontrolled HIV/AIDS complicated by concurrent TB and visceral KS. It strongly reinforces the need for clinicians to maintain a high index of suspicion for advanced HIV and opportunistic malignancy in cases of unexplained pancreatitis, particularly when imaging reveals suggestive GI or pancreatic mass lesions, even in the absence of typical cutaneous KS.
Keywords: HIV, pancreatitis, Kaposi sarcoma, tuberculosis, endoscopic ultrasound, opportunistic infections.
