Kaposi Sarcoma as a Cause of Anemia in Kidney Transplant Recipients: Two Case Reports

Kaposi Sarcoma (KS), caused by human herpesvirus 8 (HHV-8), may be observed in transplant recipients in the form of immunosuppression-related KS. While it primarily affects the skin, it can also involve internal organs, particularly the gastrointestinal (GI) system. GI involvement is often asymptomatic, but bleeding episodes may occur. Post-transplant anemia (PTA) is a common complication associated with increased mortality and decreased renal function. Early diagnosis and management are crucial. This report discusses 2 cases of KS in kidney transplant recipients presenting with severe anemia.

We report 2 cases of immunosuppression-associated KS with severe anemia in kidney transplant recipients. Case 1 involved a 50-year-old male kidney transplant recipient who developed biopsy-confirmed, skin-limited KS without systemic or gastrointestinal involvement, along with severe anemia 2 months post-transplant. The anemia was identified as pure red cell aplasia, likely induced by immunosuppressive therapy. Immunosuppressive regimen was modified by discontinuing mycophenolate mofetil and switching tacrolimus to everolimus, resulting in regression of KS lesions, normalization of hemoglobin levels, and preserved graft function. Case 2, a 47-year-old female with widespread KS involving the skin, gastrointestinal tract, and lymph nodes, was treated with paclitaxel chemotherapy, erythrocyte transfusions, and immunosuppressive adjustment. At 10-month follow-up, her disease stabilized, and hemoglobin levels returned to the normal range.

The evaluation of anemia in transplant recipients presents a complex clinical challenge. Immunosuppression-associated KS can occur during both early and late post-transplant periods. KS may contribute directly to anemia through gastrointestinal involvement or coexist as a concurrent condition alongside other underlying etiologies.