Soya Kobayashi 1 , Ayano Inui 2 , Tomoyuki Tsunoda 1 , Syuichiro Umetsu 1 , Tsuyoshi Sogo 1 , Masaaki Mori 3 , Masato Shinkai 4 , Tomoo Fujisawa 1 Show Affiliations »
Abstract
BACKGROUND: Castleman's disease (CD) is a lymphoproliferative disorder. TAFRO syndrome is classified as a variant of CD based on its key clinical manifestations of thrombocytopenia, anasarca (generalized edema and pleural effusion), fever (pyrexia), reticulin fibrosis in the bone marrow and the proliferation of megakaryocytes, and organomegaly (such as hepatosplenomegaly and multiple lymphadenopathies); TAFRO syndrome is mainly reported in Japanese patients. To our knowledge, this is the first pediatric case report detailing a CD-associated disorder progressing to cirrhosis. CASE SUMMARY: A 10-year old male patient presented with fever and anemia. Six months before hospitalization, he had remarkable abdominal distention. Subsequently, he visited a clinic for a fever that lasted 5 d. The physical findings were marked hepatosplenomegaly and cervical lymphadenopathy. A blood test revealed leukocytosis, microcytic anemia, aspartate aminotransferase-dominant transaminase elevation, high levels of C-reactive protein, polyclonal hypergammaglobulinemia, and high levels of interleukin-6 and vascular endothelial growth factor. Abdominal contrast computed tomography and magnetic resonance imaging suggested cirrhosis, which was confirmed by liver histology. Histological findings in the enlarged hepatic lymph nodes revealed both hyperplasia and atrophy of lymphoid follicles with some vascular hyperplasia and moderate plasmacytosis between the lymphoid follicles, which is compatible with lymph node histology in TAFRO syndrome. Prednisolone was not effective in reducing the patient's symptoms; therefore, the patient was prescribed tocilizumab. To date, the patient remains free of fever and continues to receive tocilizumab. CONCLUSION: We described the clinicopathological features of TAFRO syndrome to highlight the clinical presentation of this rare disease in a pediatric case. ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
BACKGROUND: Castleman's disease (CD) is a lymphoproliferative disorder . TAFRO syndrome is classified as a variant of CD based on its key clinical manifestations of thrombocytopenia , anasarca (generalized edema and pleural effusion ), fever (pyrexia ), reticulin fibrosis in the bone marrow and the proliferation of megakaryocytes, and organomegaly (such as hepatosplenomegaly and multiple lymphadenopathies); TAFRO syndrome is mainly reported in Japanese patients . To our knowledge, this is the first pediatric case report detailing a CD-associated disorder progressing to cirrhosis . CASE SUMMARY: A 10-year old male patient presented with fever and anemia . Six months before hospitalization, he had remarkable abdominal distention. Subsequently, he visited a clinic for a fever that lasted 5 d. The physical findings were marked hepatosplenomegaly and cervical lymphadenopathy . A blood test revealed leukocytosis , microcytic anemia , aspartate aminotransferase-dominant transaminase elevation, high levels of C-reactive protein , polyclonal hypergammaglobulinemia , and high levels of interleukin-6 and vascular endothelial growth factor . Abdominal contrast computed tomography and magnetic resonance imaging suggested cirrhosis , which was confirmed by liver histology. Histological findings in the enlarged hepatic lymph nodes revealed both hyperplasia and atrophy of lymphoid follicles with some vascular hyperplasia and moderate plasmacytosis between the lymphoid follicles, which is compatible with lymph node histology in TAFRO syndrome. Prednisolone was not effective in reducing the patient 's symptoms; therefore, the patient was prescribed tocilizumab . To date, the patient remains free of fever and continues to receive tocilizumab . CONCLUSION: We described the clinicopathological features of TAFRO syndrome to highlight the clinical presentation of this rare disease in a pediatric case. ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Entities: Chemical
Disease
Gene
Species
Keywords:
Case report; Castleman disease; Child; Liver cirrhosis; Multi-centric Castleman’s disease; Tocilizumab
Year: 2020
PMID： 32432144 PMCID： PMC7211522 DOI： 10.12998/wjcc.v8.i9.1656
Source DB: PubMed Journal: World J Clin Cases ISSN： 2307-8960 Impact factor: 1.337