Symptoms of Kaposi Sarcoma Beyond Skin Lesions
Kaposi sarcoma commonly involves visceral organs, lymph nodes, and mucosa beyond the characteristic cutaneous red or brown papules, particularly in AIDS-related and more aggressive forms of the disease. 1, 2
Systemic Manifestations by Anatomical Location
Oral Cavity Involvement
- Lesions on the hard and soft palate, gingiva, and tongue
- May cause difficulty eating or speaking
- Often appears as purple or red patches or nodules
Lymphatic Involvement
- Lymph node enlargement
- Lymphedema (swelling) of extremities, face, or genitalia
- Decreased mobility and function in affected limbs
Gastrointestinal Tract
- Often asymptomatic until advanced
- Fecal occult blood (detected through testing)
- Abdominal pain
- Diarrhea
- Intestinal obstruction in severe cases
- Weight loss
Pulmonary System
- Intractable cough
- Progressive dyspnea (shortness of breath)
- Fever
- Chest pain
- Hemoptysis (coughing up blood)
- Respiratory failure in advanced cases 3
Other Visceral Involvement
- Hepatosplenomegaly (enlarged liver and spleen)
- Bone involvement with pain and pathological fractures
- Central and peripheral nervous system manifestations (rare)
- Cardiac involvement (rare)
- Urinary system involvement (rare) 4
Associated Systemic Symptoms
- Unexplained fever (may indicate multicentric Castleman's disease or KSHV-associated inflammatory cytokine syndrome) 1
- Fatigue
- Weight loss
- Night sweats
- Anemia
Clinical Presentations by KS Type
AIDS-Related/Epidemic KS
- Most aggressive form with higher likelihood of visceral involvement
- More common with advanced immunosuppression (low CD4+ T-cell counts)
- Can affect multiple organ systems simultaneously
- May present with pulmonary symptoms as initial manifestation of HIV 3
Classic KS
- Generally more indolent with primarily cutaneous lesions
- Lower extremity involvement most common
- Slower progression over years to decades
Endemic/African KS
- Often involves lymph nodes, viscera, and bone
- More aggressive presentation than classic KS
Iatrogenic/Transplant-Associated KS
- Can involve lymph nodes, mucosa, and visceral organs
- Often responds to reduction of immunosuppression 1
Diagnostic Considerations
When suspecting visceral KS involvement, the workup should include:
- Fecal occult blood testing for gastrointestinal involvement
- Chest X-ray to assess for pulmonary involvement
- Upper and lower endoscopy if gastrointestinal symptoms are present
- Contrast CT of chest, abdomen, and pelvis for lymphadenopathy, visceral masses
- MRI with contrast or PET/CT scan for further evaluation of suspected lesions 1
Clinical Pitfalls
- Pulmonary KS can be mistaken for opportunistic infections in immunocompromised patients 3
- Cutaneous lesions resembling KS can be caused by other conditions (e.g., bacillary angiomatosis, cryptococcosis) 1
- KS can occur in people living with HIV who have normal CD4+ T-cell counts and viral load, so absence of severe immunosuppression does not rule out KS 1
- Visceral involvement may be present without obvious cutaneous manifestations
- Unexplained fevers in KS patients should prompt workup for multicentric Castleman's disease and KSHV-associated inflammatory cytokine syndrome 1
Understanding the full spectrum of KS symptoms beyond skin lesions is crucial for early diagnosis and management, particularly in high-risk populations.