Format

Send to

Choose Destination
BMC Infect Dis. 2016 Feb 1;16:53. doi: 10.1186/s12879-016-1378-5.

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

Anderson S1, Sasson SC2,3,4, Lee FJ5,6, Cooper W7,8,9, Larsen S10,11, Garsia R12,13.

Author information

1
Clinical Immunology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia. sand6015@uni.sydney.edu.au.
2
Clinical Immunology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia. ssas7805@med.usyd.edu.au.
3
Sydney Medical School, University of Sydney, Sydney, NSW, Australia. ssas7805@med.usyd.edu.au.
4
Level 6 Laboratory Services Building, Royal Prince Alfred Hospital, Missenden Rd Camperdown, Sydney, NSW, Australia. ssas7805@med.usyd.edu.au.
5
Clinical Immunology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia. Frederick.Lee@sswahs.nsw.gov.au.
6
Sydney Medical School, University of Sydney, Sydney, NSW, Australia. Frederick.Lee@sswahs.nsw.gov.au.
7
Sydney Medical School, University of Sydney, Sydney, NSW, Australia. wendy.cooper@sydney.edu.au.
8
Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. wendy.cooper@sydney.edu.au.
9
School of Medicine, University of Western Sydney, Parramatta, NSW, Australia. wendy.cooper@sydney.edu.au.
10
Sydney Medical School, University of Sydney, Sydney, NSW, Australia. stephen.larsen@sswahs.health.nsw.gov.au.
11
Haematology Department Royal Prince Alfred Hospital, Sydney, NSW, Australia. stephen.larsen@sswahs.health.nsw.gov.au.
12
Clinical Immunology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia. r.garsia@sydney.edu.au.
13
Sydney Medical School, University of Sydney, Sydney, NSW, Australia. r.garsia@sydney.edu.au.

Abstract

BACKGROUND:

Multicentric 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 PRESENTATION:

A 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.

CONCLUSIONS:

MCD 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.

PMID:
26831502
PMCID:
PMC4736249
DOI:
10.1186/s12879-016-1378-5
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center