title: Gastrointestinal Bleeding and Diffuse Skin Thickening as Kaposi Sarcoma Clinical Presentation.
abstract: A 56-year-old African patient received a kidney from a deceased donor with 4 HLA mismatches in April 2013. He received immunosuppression with basiliximab, tacrolimus, mycophenolate mofetil, and prednisone. Immediate diuresis and a good allograft function were soon observed. Six months later, the serum creatinine level increased to 2.6 mg/dL. A renal allograft biopsy revealed interstitial fibrosis and tubular atrophy grade II. Toxicity of calcineurin inhibitor was assumed and, after a switch for everolimus, renal function improved. However, since March 2014, renal function progressively deteriorated. A second allograft biopsy showed no new lesions. Two months later, the patient was admitted due to anuria, haematochezia with anaemia, requiring 5 units of packed red blood cells, and diffuse skin thickening. Colonoscopy showed haemorrhagic patches in the colon and the rectum; histology diagnosis was Kaposi sarcoma (KS). A skin biopsy revealed cutaneous involvement of KS. Rapid clinical deterioration culminated in death in June 2014. This case is unusual as less than 20 cases of KS with gross gastrointestinal bleeding have been reported and only 6 cases had the referred bleeding originating in the lower gastrointestinal tract. So, KS should be considered in differential diagnosis of gastrointestinal bleeding in some kidney transplant patients.
authors.affiliation: Department of Nephrology, Centro Hospitalar do Médio Tejo, Avenida Xanana Gusmão, Apartado 45, 2350-754 Torres Novas, Portugal.
authors.forename: Sara
authors.initials: S
authors.lastname: Querido
authors.affiliation: Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Avenida Professor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal.
authors.forename: Henrique Silva
authors.initials: HS
authors.lastname: Sousa
authors.affiliation: Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Avenida Professor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal.
authors.forename: Tiago Assis
authors.initials: TA
authors.lastname: Pereira
authors.affiliation: Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Avenida Professor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal.
authors.forename: Rita
authors.initials: R
authors.lastname: Birne
authors.affiliation: Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Avenida Professor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Matias
authors.affiliation: Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Avenida Professor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal.
authors.forename: Cristina
authors.initials: C
authors.lastname: Jorge
authors.affiliation: Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Avenida Professor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal.
authors.forename: André
authors.initials: A
authors.lastname: Weigert
authors.affiliation: Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Avenida Professor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal.
authors.forename: Teresa
authors.initials: T
authors.lastname: Adragão
authors.affiliation: Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Avenida Professor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal.
authors.forename: Margarida
authors.initials: M
authors.lastname: Bruges
authors.affiliation: Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Avenida Professor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal.
authors.forename: Domingos
authors.initials: D
authors.lastname: Machado