César Redondo-Bermúdez

Ménétrier's disease and Kaposi's sarcoma in a HIV-positive patient

A 39-year-old male presents with burning epigastric pain, nausea, early satiety, vomiting, soft stools, 7 kg weight loss, asthenia, and adynamia for four months. Two weeks before his admission to hospital he had progressive edema in the lower extremities, and an episode of hematemesis. He had a history of syphilis that was treated 18 years ago. Upon admission he had anasarca and mucocutaneous pallor. Examination revealed epigastric tenderness with fluid wave and no masses or visceromegalies. Purple, vascular-looking, non-bleeding macules were seen on the hard palate, tongue floor, and glans, with laceration of the balano-preputial sulcus and grade-III edema in the lower limbs. ELISA found HIV positivity, which was confirmed with Western Blot, in addition to hypoproteinemia of unclear origin; cardiac, hepatic, renal, and nutritional causes were excluded. Contrast-enhanced abdominal tomography revealed a polypoid thickening of gastric walls, and upper digestive endoscopy demonstrated an extensive, diffuse, multinodular, exophytic gastric lesion predominant in the body and fundus. The histopathologic study of the gastric biopsy showed severe foveolar cell proliferation resulting in deep invaginations and replacement of the original oxyntic mucosa. A KS was seen at the lamina propria, which was confirmed by immunolabeling for human herpes virus, type 8 (HHV8) (Fig. 1). Antiretroviral therapy was initiated, and subsequent chemotherapy with anthracyclines was scheduled.