A 48-year-old human immunodeficiency virus (HIV) positive male patient presented with two months history of intermittent left iliac fossa pain, tenesmus, and gradual enlargement of fingertips. He denied diarrhea, cough, fever and weight loss. Home medications included recent initiation of highly active antiretroviral therapy (HAART). A recent digital clubbing and edema in lower limbs were observed. Biochemical markers were normal, including amylase, lipase, albumin, and liver function panel. Evaluation with computed tomography imaging of the thorax/abdomen/pelvis was unremarkable. After five months of the first endoscopic examination performed during his hospitalization, a new endoscopy and colonoscopy with biopsy were ordered. The biopsy specimens revealed whorls of spindle-shaped cells and neovascularization with small-vessel proliferation suggestive of Kaposi sarcoma (KS). Immuno-histochemical testing for human herpes virus 8 (HHV-8) was positive, supporting the KS diagnosis.