SHM Converge Scientific Abstract ePoster Gallery-An Unfortunate Trio: Esophageal Kaposi Sarcoma, Immune Thrombocytopenia, and Uremia-Induced Platelet Dysfunction

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This case describes a 46-year-old man with newly diagnosed advanced HIV infection who developed multiple conditions that together caused severe gastrointestinal bleeding. He presented with a year of chronic cough, worsening shortness of breath, and new hemoptysis. Examination revealed bleeding, umbilicated facial lesions. Testing showed profound immunosuppression with a CD4 count of 0.1. Chest CT demonstrated right perihilar consolidation, and cerebrospinal fluid plus skin lesion biopsy identified cryptococcal infection, prompting amphotericin treatment.<br /><br />During hospitalization, the patient developed acute kidney injury likely related to amphotericin, with creatinine rising to 9.7 and urinalysis showing muddy casts. As his condition worsened, hemoptysis increased and hemoglobin fell to 6.3 g/dL, with platelets dropping from a baseline of 297 to 95 x 10^9/L. Blood transfusion was started and endoscopy was planned.<br /><br />Upper endoscopy revealed vascularized, friable esophageal mucosa consistent with esophageal Kaposi sarcoma, an uncommon but important cause of GI bleeding in HIV, especially since distal GI involvement may be clinically silent. The authors also highlight two additional contributors to hemorrhage: HIV-related immune thrombocytopenia, caused by antiplatelet antibodies and known to occur in up to 30% of patients with HIV, and uremia-induced platelet dysfunction from amphotericin-associated nephrotoxicity, which impairs platelet adhesion and activation.<br /><br />Overall, the report emphasizes that severe bleeding in advanced HIV may result from overlapping infectious, neoplastic, and hematologic complications, and that recognizing each contributor is critical for management.

Asset Subtitle

Elizabeth Holland

Meta Tag

Author List Elizabeth Holland, Faizan Malik, Mark E. O'Brien, Yichi Zhang

Category Clinical Vignettes

Concept HIV

Concept Esophageal Kaposi Sarcoma

Concept Upper Gastrointestinal Bleeding

Concept HIV-related Immune Thrombocytopenia

Concept Platelet Dysfunction

Distinguished Non-Finalist

Presenter Organization LSU Medical School

Presenting Author Elizabeth Holland

Track Adult

Keywords

advanced HIV infection

gastrointestinal bleeding

esophageal Kaposi sarcoma

cryptococcal infection

amphotericin nephrotoxicity

acute kidney injury

hemoptysis

immune thrombocytopenia

uremia-induced platelet dysfunction

endoscopy

HIV

Esophageal Kaposi Sarcoma

Upper Gastrointestinal Bleeding

HIV-related Immune Thrombocytopenia

Platelet Dysfunction