We present the case of a 49 year old man who had suffered histologically confirmed ulcerative colitis (UC) since 1998. He had been asymptomatic for four years when in August 2002 an acute relapse developed. Colonoscopy and histology of a superficial bowel specimen showed clear signs of active UC with no signs of malignancy. Despite adequate therapy he failed to improve and was referred for restorative proctocolectomy because of steroid dependency and end stage colon. By the time of his referral, violaceous reddish-brown nodules had developed on his extremities. Skin biopsy showed spindle cells and vascular slits. Histological diagnosis was Kaposi’s sarcoma (KS) of the skin. He underwent a restorative proctocolectomy with ileostomy in March 2003. The pathological examination of the colon showed features of UC and surprisingly, characteristic signs of KS also. Human immunodeficiency virus (HIV) tests …