Successful treatment of iatrogenic multicentric Castleman's disease arising due to recrudescence of HHV-8 in a liver transplant patient.

Abstract

We describe the case of a 59-year-old HIV-negative male who developed multicentric Castleman's disease (MCD) 1 year postliver transplantation due to recrudescence of a pretransplant human herpesvirus-8 (HHV-8) infection. He presented with fevers, dry cough, weight loss and drenching night sweats. Routine investigations were all unremarkable. Computerized axial tomography (CT) scans showed splenomegaly and intra-abdominal lymphadenopathy, confirmed by positron emission tomography. Cervical lymph node biopsies were consistent with MCD. The presence of HHV-8 was confirmed on immunohistochemistry. Peripheral blood HHV-8 quantitative polymerase chain reaction (qPCR) monitoring showed a threefold decrease in viremia in the first week of treatment with ganciclovir but had little impact on clinical symptoms. Reducing immunosuppression and switching to rituximab resolved clinical symptoms and produced a negative HHV-8 qPCR result. Retrospective molecular testing of sera collected pre- and immediately posttransplantation confirmed preexisting HHV-8 in the host. This is the first reported case of an HIV-negative postliver transplant patient developing MCD that manifested as posttransplant lymphoproliferative disorder due to recrudescence of HHV-8. We propose (1) the introduction of the term iatrogenic Castleman's disease (CD) for this and similar cases, (2) rituximab should be considered as a treatment option for CD and (3) consideration be given to a change to the World Health Organization classification of CD to incorporate such cases.

• Authors: D J Speicher, M M Sehu, P Mollee, L Shen, N W Johnson, J L Faoagali
• Journal: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons (Am J Transplant) Vol. 14 Issue 5 Pg. 1207-13 (May 2014) ISSN: 1600-6143 [Electronic] United States
• PMID: 24674650 (Publication Type: Case Reports, Journal Article)
• Copyright: © Copyright 2014 The American Society of Transplantation and the American Society of Transplant Surgeons.

Chemical References

• Antibodies, Monoclonal, Murine-Derived
• Immunologic Factors
• Rituximab

Topics

• Antibodies, Monoclonal, Murine-Derived (therapeutic use)
• Castleman Disease (drug therapy, virology)
• HIV Seronegativity
• Herpesviridae Infections (drug therapy, virology)
• Herpesvirus 8, Human (isolation & purification)
• Humans
• Iatrogenic Disease (prevention & control)
• Immunologic Factors (therapeutic use)
• Liver Diseases (complications, surgery, virology)
• Liver Transplantation
• Male
• Middle Aged
• Phylogeny
• Prognosis
• Rituximab