Recurrent Inflammatory Flares in HIV-Infected Patients: Consider Castleman Disease!

J Investig Med High Impact Case Rep. 2017 Sep 8;5(3):2324709617725094. doi: 10.1177/2324709617725094. eCollection 2017 Jul-Sep.

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.

Keywords: Castleman disease; HIV infection; etoposide; inflammatory flares; rituximab; treatment.