PMC5253505_01
(a) Gastric Kaposi sarcoma: scarlet slightly elevated lesions of the antral gastric mucosal surface (upper gastrointestinal endoscopy). (b) Mediastinal ganglia Kaposi sarcoma: submucosal vascular spindle-shaped cells (H&E-stain, 100x). (c) Candida spp. in colon (Grocott methenamine silver-stain, 100x). (d) Candida spp. in lung and hyaline membranes suggesting acute respiratory distress syndrome (H&E-stain, 100x). (e) Bone marrow hemophagocytosis (H&E-stain, 400x). (f) Progressive multifocal leukoencephalopathy: enlarged homogeneous oligodendrocyte nucleus with inclusion (H&E-stain, 100x). (g) Cerebral toxoplasmosis: Toxoplasma cyst (H&E-stain, 100x). (h) Cardiac toxoplasmosis: Toxoplasma cyst (H&E-stain, 100x).
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Upper and lower endoscopy revealed multiple polypoid lesions with a cherry-red appearance in the stomach and colon, compatible with Kaposi sarcoma (Figure 1(a)). AIDS, would be sufficient to explain the poor outcome but the autopsy opened an unexpected underworld: Kaposi sarcoma was confirmed in the stomach and colon but also in the esophagus and mediastinal lymph nodes (Figure 1(b)); Candida species was found in the anal canal, colon (Figure 1(c)), and lung, where hyaline membranes compatible with an acute respiratory distress syndrome were also seen (Figure 1(d)). As previously suspected, prominent phagocytosis of blood cells in the bone marrow confirmed hemophagocytic syndrome (Figure 1(e)); brain histology showed enlarged oligodendroglial cells nucleus with ground glass inclusions consistent with PML (Figure 1(f)); multiple basophilic dot-like parasites in cysts were documented in cerebral (Figure 1(g)) and heart tissues (Figure 1(h)) configuring cerebral and myocardial toxoplasmosis.