Immune reconstitution inflammatory syndrome associated with acquired immunodeficiency syndrome-related gastrointestinal limited Kaposi's sarcoma presenting as acute intestinal obstruction: a case report

INTRODUCTION: Immune reconstitution inflammatory syndrome during anti-retroviral treatment of acquired immunodeficiency syndrome (AIDS) -associated gastrointestinal Kaposi's sarcoma has rarely been reported. CASE PRESENTATION: A 36-year-old Asian Indian male, newly diagnosed with AIDS and treatment naïve, was started on highly active antiretroviral therapy (HAART). He developed acute intestinal obstruction after four weeks of therapy. A laparotomy was done with excision and adhesiolysis leading to relief of symptoms. A histology report revealed the lesion to be Kaposi's sarcoma. Our patient was diagnosed to be having immune reconstitution inflammatory syndrome associated with AIDS-associated gastrointestinal limited Kaposi's sarcoma, which presented as acute intestinal obstruction. Our patient was treated with paclitaxel post-operatively and HAART was continued. Our patient responded to therapy. CONCLUSION: Immune reconstitution inflammatory syndrome involving Kaposi's sarcoma may occur in HAART-naïve individuals with AIDS-related Kaposi's sarcoma. Gastrointestinal Kaposi's sarcoma may present with sudden increase in size or inflammation leading to acute intestinal obstruction. This does not indicate failure of HAART or a need for changes in anti-retroviral regimen.