Episodic fevers and vasodilatory shock mimicking urosepsis in a patient with HIV-associated multicentric Castleman’s Disease: a case report

BMC Infectious Diseases

Case Report

Stephanie Anderson¹  Frederick J. Lee²  Roger Garsia²  Sarah C. Sasson³  Stephen Larsen⁴  Wendy Cooper⁵ 

[1] Clinical Immunology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia;Clinical Immunology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia;Sydney Medical School, University of Sydney, Sydney, NSW, Australia;Clinical Immunology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia;Sydney Medical School, University of Sydney, Sydney, NSW, Australia;Level 6 Laboratory Services Building, Royal Prince Alfred Hospital, Missenden Rd Camperdown, Sydney, NSW, Australia;Sydney Medical School, University of Sydney, Sydney, NSW, Australia;Haematology Department Royal Prince Alfred Hospital, Sydney, NSW, Australia;Sydney Medical School, University of Sydney, Sydney, NSW, Australia;Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia;School of Medicine, University of Western Sydney, Parramatta, NSW, Australia;

关键词: Multicentric Castleman’s disease;    MCD;    HHV-8;    Human herpes virus-8;    HIV;    Fevers;    Shock;    Rituximab;    Systemic inflammatory response syndrome;    SIRS;   

DOI  :  10.1186/s12879-016-1378-5

 received in 2015-11-10, accepted in 2016-01-25,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundMulticentric Castleman’s disease (MCD) is a pre-malignancy that presents with lymphadenopathy and features of systemic inflammation. Human immunodeficiency virus (HIV)-associated MCD is associated with human herpesvirus-8 (HHV-8) infection. If untreated MCD has a relapsing and remitting course that is eventually fatal.Case presentationA 67-year-old man had six hospital admissions over 20 months characterised by fever, urinary frequency and CRP >100 mg/L. The final admission was complicated by hypotension requiring intensive care unit admission and ionotropic support. His history included HIV and Hepatitis B virus (HBV) co-infection on suppressive therapy. Each presentation was managed as presumed urosepsis with use of empirical antibiotics, however numerous blood and urine cultures failed to identify a pathogen. A bone-marrow aspirate and trephine found no evidence of haematological malignancy. A positron emission tomography scan found active lymph nodes, one of which was biopsied and found to contain the plasma-cell variant of Castleman’s disease. Ultimately the cause for the recurrent presentations was attributed to progressive MCD. The patient received rituximab monotherapy and has had no further related admissions.ConclusionsMCD should be considered in patients with chronic HIV infection presenting with recurrent sepsis-like episodes and/or vasodilatory shock, particularly if no pathogen is identified or lymphadenopathy is evident.

【 授权许可】

CC BY   
© Anderson et al. 2016