Colon ulcers and HIV: an image to remember.

A 37-year-old HIV-positive male with a history of cutaneous Kaposi's sarcoma (KS) presented with chronic bloody diarrhea, abdominal pain, and weight loss despite an undetectable viral load and a CD4 count of 200 cells/mm³. Colonoscopy and gastroscopy revealed ulcers with erythematous-violaceous borders, and biopsies confirmed intestinal KS through HHV-8 positivity. Treated with paclitaxel, the patient showed significant clinical and endoscopic improvement. Visceral KS, though rare at higher CD4 counts, should be suspected in compatible cases. It often presents as diarrhea and abdominal pain, with or without skin lesions. Diagnosis requires HHV-8-positive biopsies, and treatment includes antiretroviral therapy and chemotherapy, such as paclitaxel or liposomal doxorubicin.