Beyond Crohn's disease: ileal Kaposi sarcoma in a transplant recipient presenting with subocclusive symptoms. A concomitant diagnosis of Crohn's disease and ileal Kaposi sarcoma.

BACKGROUND

Intestinal Kaposi sarcoma (KS) is a rare but clinically significant complication in immunosuppressed patients, particularly in solid-organ transplant recipients, and may closely mimic inflammatory bowel disease (IBD). Its coexistence with Crohn's disease (CD) represents an exceptional diagnostic and therapeutic challenge.

CASE PRESENTATION: We report the case of a 69-year-old kidney transplant recipient receiving chronic immunosuppressive therapy (everolimus, tacrolimus, and prednisone) who presented with recurrent subocclusive symptoms requiring ileocecal resection. Histological examination confirmed Crohn's disease and unexpectedly revealed a localized HHV8-positive Kaposi sarcoma within the stenotic ileal segment, without evidence of systemic dissemination. Given the absence of extraintestinal involvement and the complete surgical excision of the lesion, a multidisciplinary team opted to maintain immunosuppressive therapy and avoid systemic chemotherapy. During long-term follow-up, the patient remained free of KS recurrence, with stable graft function and endoscopic remission of Crohn's disease.

CONCLUSIONS

This case highlights the importance of considering intestinal Kaposi sarcoma in the differential diagnosis of refractory or atypical Crohn's disease in immunosuppressed patients. It also suggests that, in carefully selected cases with localized disease, surgical resection alone may represent an effective therapeutic strategy, allowing continuation of essential immunosuppressive therapy.