SHM Converge Scientific Abstract ePoster Gallery-Human Herpesvirus-8 and Multicentric Castleman's Disease in a 31-Year-Old Male With Hiv

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This case describes a 31-year-old man with HIV, a low CD4 count, and known Kaposi sarcoma who presented with fever, dyspnea, cough, abdominal distention, and edema. Imaging showed bilateral loculated pleural effusions, diffuse lymphadenopathy, hepatosplenomegaly, and ascites. Despite broad infectious workup and empiric antibiotics, he rapidly deteriorated with shock, respiratory failure, acute kidney injury, and severe inflammatory findings, including very high ferritin and worsening cytopenias.<br /><br />The differential diagnosis included bacterial pneumonia, immune reconstitution inflammatory syndrome, hemophagocytic lymphohistiocytosis, primary effusion lymphoma, Kaposi sarcoma progression, and multicentric Castleman disease (MCD). Biopsy and pathology ultimately confirmed HHV-8 positivity and MCD after death. The case highlights how HHV-8–associated conditions in patients with HIV can present with overlapping features of infection, malignancy, and immune dysregulation, making diagnosis difficult.<br /><br />The discussion emphasizes that MCD can cause fever, lymphadenopathy, hepatosplenomegaly, edema, cytopenias, hyponatremia, and multi-organ failure through cytokine-driven inflammation, especially IL-6. Although ART has improved outcomes in HIV, HHV-8-associated malignancies and lymphoproliferative disorders remain serious risks. Early biopsy is critical when clinical decline is unexplained, as rapid progression can be fatal. Treatment options such as rituximab and doxorubicin may help in some cases, but outcomes can still be poor in severe disease.

Asset Subtitle

Philip K. Angelides

Meta Tag

Author List Kelli A. Bagwell, Philip K. Angelides

Category Clinical Vignettes

Concept Human Herpesvirus 8

Concept HIV

Concept Multicentric Castleman Disease

Concept Kaposi Sarcoma

Concept Primary Effusion Lymphoma

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine

Presenting Author Philip K. Angelides

Track Adult

Keywords

HIV

Kaposi sarcoma

HHV-8

multicentric Castleman disease

lymphadenopathy

hepatosplenomegaly

pleural effusion

cytopenias

ferritin

cytokine storm

Human Herpesvirus 8

HIV

Multicentric Castleman Disease

Kaposi Sarcoma

Primary Effusion Lymphoma