Abstract
Background. Transient inflammatory flares are common in clinical care of human immunodeficiency virus (HIV)–infected patients. In-depth investigations are not performed routinely because patients often recover without therapeutic interventions, and therefore, the etiologies of these inflammatory flares frequently remain unknown. Case. We report a case of an HIV-infected patient with recurrent inflammatory flares during several years in whom diagnostic workup with a lymph node biopsy finally revealed multicentric Castleman disease (MCD). The patient was treated with etoposide and rituximab until November 2013 and achieved ongoing complete clinical remission. Conclusion. Recent effective therapeutic regimens offer an opportunity to prevent serious complications of MCD including its malignant transformation, provided that the diagnosis is established early enough. Therefore, clinicians should consider MCD in the differential diagnosis of self-limiting inflammatory flares, especially in HIV-infected patients.
Highlights
Transient inflammatory flares are common in clinical care of human immunodeficiency virus (HIV)–infected patients, even in the setting of a well-controlled infection
We report a case of an HIV-infected patient with recurrent inflammatory flares in whom broader diagnostic workup revealed multicentric Castleman disease (MCD), and could be treated successfully with achievement of ongoing clinical remission
In February 2004, he presented with a cutaneous Kaposi sarcoma on the right foot
Summary
Transient inflammatory flares are common in clinical care of human immunodeficiency virus (HIV)–infected patients, even in the setting of a well-controlled infection. Since March 2010, the patient suffered from recurrent inflammatory flares with high fever, myalgia, arthralgia, and nasal congestion (Figure 1a) These bouts were accompanied by normocytic normochromic anemia followed by thrombocytosis and elevated inflammatory markers. These episodes responded well to anti-inflammatory drugs with defervescence, normalization of C-reactive protein (CRP) values and thrombocyte counts, as well as complete regression of lymphadenopathy and myalgia, and were interpreted as inflammatory reactions to viral pathogens. Treatment was initiated with 1-cycle etoposide induction and 4 weekly rituximab, followed by 4 administrations of rituximab every other month as consolidation until November 2013 This led to a rapid resolution of all symptoms, diminution of lymphadenopathy, and normalization of CRP and anemia. Until the last clinical visit in September 2016, about 30 months after initiation of the chemotherapy, there was complete clinical remission without further inflammatory flares
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