Beyond the Skin: Gastrointestinal Bleeding as a First Sign of Duodenal Kaposi Sarcoma

Duodenal Kaposi sarcoma (KS) without cutaneous involvement is rare and may be diagnostically overlooked because gastrointestinal (GI) involvement can be clinically silent until complications occur. We present a 38-year-old man with a 6-year history of untreated HIV, found to have duodenal KS on endoscopic biopsy before any skin lesions. This case highlights that visceral KS should be considered in the differential diagnosis of upper GI bleeding in advanced HIV even in the absence of cutaneous findings, given the prognostic implications and higher mortality associated with GI involvement.