SHM Converge Scientific Abstract ePoster Gallery-HHV 8 Associated Multicentric Castleman Disease in Hiv: Diagnosis Made Only by Excisional Lymph Node Biopsy

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This case report describes a middle-aged man with chronic HIV on ART who presented with persistent high fevers, malaise, odynophagia, cough, emesis, pancytopenia, elevated LDH, splenomegaly, and widespread abdominopelvic lymphadenopathy. Initial evaluation included broad infectious testing, which was negative. Bone marrow biopsy showed mildly hypercellular marrow with focal hemophagocytosis, but cytogenetics, flow cytometry, and molecular studies were nondiagnostic.<br /><br />The patient later returned with recurrent fever and pleuritic chest/flank pain. Repeat CT imaging showed progressive lymphadenopathy, worsening splenomegaly, and a new splenic infarct. A percutaneous inguinal lymph-node core biopsy was also nondiagnostic. Because suspicion remained high, an excisional inguinal lymph-node biopsy was performed. Histopathology demonstrated classic features of HHV-8–associated multicentric Castleman disease (MCD), including atretic germinal centers, mantle-zone “onion-skinning,” vascular proliferation, polytypic plasmacytosis, and patchy HHV-8 LANA-1 positivity.<br /><br />The report emphasizes that HHV-8–associated MCD should be strongly considered in HIV-positive patients with unexplained fever, cytopenias, splenomegaly, and generalized lymphadenopathy. It can mimic other systemic inflammatory syndromes, and bone marrow or core biopsy may be nonspecific or miss key diagnostic architecture. Therefore, when initial studies are inconclusive, prompt excisional lymph-node biopsy is the diagnostic gold standard.<br /><br />The patient improved with supportive care and continuation of ART, with normalization of platelets and improvement in cytopenias. Hematology planned outpatient rituximab-based therapy.

Asset Subtitle

Yves Najm Mrad

Meta Tag

Author List Bacel Nseir, Hiba Fala, Yves Najm Mrad

Category Clinical Vignettes

Concept KSHV-Associated Multicentric Castleman Disease

Concept Excisional Biopsy

Concept Human immunodeficiency virus infection

Concept Fever

Concept Cytopenia

Distinguished Non-Finalist

Presenter Organization University of Houston/Hca Houston Clear Lake

Presenting Author Yves Najm Mrad

Track Adult

Keywords

HIV

HHV-8

multicentric Castleman disease

lymphadenopathy

splenomegaly

pancytopenia

fever

bone marrow biopsy

excisional lymph node biopsy

rituximab

KSHV-Associated Multicentric Castleman Disease

Excisional Biopsy

Human immunodeficiency virus infection

Fever

Cytopenia