11/27. Multicentric Castleman's disease, non-Hodgkin's lymphoma, and Kaposi's sarcoma: a rare simultaneous occurrence.A rare simultaneous occurrence of multicentric Castleman's disease, non-Hodgkin's lymphoma, and Kaposi's sarcoma was diagnosed in a 70-year-old man who presented with fever, polyarthralgia, weight loss, vascular purpura, anemia, generalized lymphadenopathy, and hepatosplenomegaly. He had no risk of HIV infection and serological tests for HIV were negative twice, but a low number of T-cells and a reversed CD4/CD8 ratio were observed. During hospitalization, he developed Kaposi's sarcoma at the right sole. Lymph node biopsies revealed multicentric Castleman's disease together with a large B-cell lymphoma, which showed monotypic IgM-lambda lymphocytes. To our knowledge, this is the first report in which systemic manifestations of all three diseases occurred simultaneously prior to any specific treatment. The altered immune status and human herpesvirus-8 infection might have played a role in the pathogenesis of this occurrence.- - - - - - - - - - ranking = 1keywords = herpesvirus (Clic here for more details about this article) |
12/27. Acquired haemophilia in HIV negative, HHV-8 positive multicentric Castleman's disease: a case report.Multicentric Castleman's Disease (MCD) is an atypical lymphoproliferative disorder, related to human herpesvirus 8 (HHV-8) infection and often associated with autoimmune diseases such as haemolytic anaemia and thrombocytopenia. Acquired haemophilia (AH) is a rare, life-threatening disease, which can occur in association with lymphoproliferative disorders, although only one case of AH in MCD has been described so far. We report the case of a human immuno deficiency virus negative 71-yr-old woman referred to our hospital for prolonged bleeding on surgical site following a lymph node biopsy. Lymph node histology revealed MCD, while the screening for the bleeding disorder showed prolonged activated partial thromboplastin time (APTT) (ratio: 1.89, normal value <1.24), low factor viii (FVIII:C) levels (6%) with anti-factor viii antibodies (2.3 Bethesda units), leading to a diagnosis of AH. Virological studies on plasma, lymphocyte and bronchoalveolar wash showed positivity for HHV-8 infection. Treatment with steroids (metilprednisolone 1-1.5 mg/kg/d) and cyclophosphamide (100 mg/d orally) was unsuccessful, and then antiviral therapy with cidofovir (5 mg/kg/wk) was started. A transient normalisation of APTT was seen after two administrations of cidofovir, but then coagulation parameters worsened and a large haematoma of the arm appeared. Bleeding was successfully stopped with two boluses of recombinant activated factor VII (Novoseven 90 microg/kg). Therapy with anti-CD 20 monoclonal antibody rituximab (Mabthera 375 mg/m2 once a week for 4 wk) was started, and following two administrations APTT normalised once again. Cardiological and neurological complications arose before the third dose of rituximab and the patient died shortly afterwards.- - - - - - - - - - ranking = 1keywords = herpesvirus (Clic here for more details about this article) |
13/27. Alleviation of systemic manifestations of multicentric Castleman's disease by thalidomide.Multicentric Castleman's disease (MCD) is a rare lymphoproliferative disorder of unknown etiology. Although HHV-8 (human herpesvirus type 8) has been suggested as a possible etiologic agent in a subpopulation of cases, appropriate treatment of the HHV-8 infection has not produced regression of the disease. Additionally, other treatment modalities, including steroids and various regimens of chemotherapy, do not consistently provide good control of the disease. Clinical signs and symptoms of the disease are primarily mediated by cytokines, especially interleukin-6 (IL-6). We report a case of multicentric Castleman's disease that responded dramatically to single agent thalidomide. A powerful cytokine disruptor, thalidomide may have good therapeutic efficacy in treating MCD and related cytokine-mediated disorders.- - - - - - - - - - ranking = 1keywords = herpesvirus (Clic here for more details about this article) |
14/27. Epstein-Barr virus and human herpesvirus 8 coinfection and concomitant extranodal nasal-type NK/T cell lymphoma and Castleman disease: case report.We describe a 36-year-old man uninfected with human immunodeficiency virus who had confirmed concurrent infection with Epstein-Barr virus (EBV) and human herpesvirus 8 (HHV-8) and their respective lymphoproliferative manifestations, nasal-type NK/T cell lymphoma and Castleman disease. antibodies to HHV-8 and EBV dna were found in plasma and peripheral blood mononuclear cells. An EBV-positive nasal-type NK/T cell lymphoma infiltrated the splenic red pulp, whereas the white pulp contained HHV-8-positive plasmablasts, as found in Castleman disease.- - - - - - - - - - ranking = 5keywords = herpesvirus (Clic here for more details about this article) |
15/27. Human herpesvirus-8-positive microvenular hemangioma in poems syndrome.We report a case of POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome in a 55-year-old African American woman in which human herpesvirus-8 (HHV-8) was demonstrated within rare lymphocytes in a Castleman disease lymph node biopsy and numerous endothelial cells and lymphocytes in a microvenular hemangioma skin biopsy. Initial symptoms and findings of night sweats, weight loss, anorexia, generalized lymphadenopathy, and hemangiomas improved after chemotherapy with cyclophosphamide and prednisone. However, in the year following the initial diagnosis, the patient suffered from recurrent bouts of night sweats, gastroparesis, and lymphadenopathy, which required further treatment with plasmapheresis, cyclophosphamide, prednisone, and rituximab. One year later, the patient is asymptomatic but has persistent gammopathy. Although HHV-8 has previously been detected in POEMS-associated Castleman disease tissue, to our knowledge, this is the first case report in which HHV-8 has been directly demonstrated within the endothelial cells of a POEMS-associated hemangioma.- - - - - - - - - - ranking = 5keywords = herpesvirus (Clic here for more details about this article) |
16/27. Multicentric Castleman's disease treated with antivirals and immunosuppressants.A patient negative for human immunodeficiency virus (HIV) developed multicentric Castleman's disease (MCD) and Kaposi's sarcoma (KS) associated with active human herpesvirus 8 (HHV-8) infection. He was treated with sequential antiviral therapy, chemotherapy, and corticosteroids. HHV-8 levels were monitored throughout the course of the patient's illness, and were found to rise on relapse. No consistent change in HHV-8 levels was found with antiviral therapy. We demonstrate that in this patient antiviral therapy was clinically ineffective, and did not alter HHV-8 levels, but that corticosteroid and combination chemotherapy led to clinical improvement. Despite the implication of HHV-8 as a cause of MCD, few studies have correlated HHV-8 levels with clinical response.- - - - - - - - - - ranking = 1keywords = herpesvirus (Clic here for more details about this article) |
17/27. Primary pulmonary hypertension, Castleman's disease and human herpesvirus-8.Primary pulmonary hypertension (PPH) and Castleman's disease (CD) are rare conditions infrequently encountered in clinical practice. In this paper, two patients diagnosed with both of these diseases are reported. The authors speculate that rather than being a chance occurrence, these conditions are linked by a common angio-proliferative mechanism. Therefore, an association between infection with the human herpesvirus-8 and the diseases of PPH and CD was sought. Evidence of human herpesvirus-8 infection was found in the lung tissue and, specifically, in the plexiform lesions from one of the patients.- - - - - - - - - - ranking = 6keywords = herpesvirus (Clic here for more details about this article) |
18/27. Remission of HHV-8 and HIV-associated multicentric Castleman disease with ganciclovir treatment.Multicentric Castleman disease (MCD) is a lymphoproliferative disorder associated with human herpesvirus 8 (HHV-8) infection among persons with human immunodeficiency virus (HIV) infection. Treatment often includes chemotherapy, and progression to non-Hodgkin lymphoma frequently occurs. MCD is characterized in part by active HHV-8 replication, and many of the symptoms of MCD may be attributable to viral gene products. We describe the effect of ganciclovir on the clinical and virologic course of MCD in a series of 3 case reports. Two patients experienced a reduction in the frequency of episodic flares of MCD and detectable HHV-8 dna with intravenous or oral ganciclovir, whereas the third patient recovered from an acute episode of renal and respiratory failure with intravenous ganciclovir therapy. These data provide in vivo evidence for the utility of antiviral agents against HHV-8 in the management of MCD.- - - - - - - - - - ranking = 1keywords = herpesvirus (Clic here for more details about this article) |
19/27. Human herpesvirus 8 and Epstein-Barr virus-related monotypic large B-cell lymphoproliferative disorder coexisting with mixed variant of Castleman's disease in a lymph node of a renal transplant recipient.Human herpesvirus 8 (HHV8) has been related to some malignant lymphoproliferations, including post-transplant lymphoproliferative disorders (PTLD). We describe a case of a HHV8 and Epstein-Barr virus (EBV) positive large B-cell lymphoproliferation coexisting with Castleman's disease in the same lymph node of a long-term renal transplant recipient. biopsy revealed mixed type of Castleman's disease and anaplastic cells showing IgA restriction, although molecular analysis failed to detect monoclonality. Only large cells were co-infected by both EBV and HHV8. After reduction of immunosuppression, the lesion partially regressed. After 1 yr, local evolution required surgery followed by irradiation. The present case represents a unique form of localized monotypic but polyclonal large cell PTLD associated with Castleman's disease. It can be added to PTLD with HHV8 and EBV co-infection.- - - - - - - - - - ranking = 5keywords = herpesvirus (Clic here for more details about this article) |
20/27. Resolution of AIDS-related Castleman's disease with anti-CD20 monoclonal antibodies is associated with declining IL-6 and TNF-alpha levels.A 32-year-old hiv-1 positive man was diagnosed with Castleman's disease following a long history of constitutional symptoms. Primary therapy with single agent rituximab was associated with a near complete response. During this time, his KSHV (Kaposi's sarcoma-associated herpesvirus) viral load decreased and we also observed immediate, large and sustained decreases in interleukin-6 (IL-6) and tumor necrosis factor-alpha levels (TNF-alpha). This highlights the close association between circulating cytokines such as IL-6 and virally-induced malignancy.- - - - - - - - - - ranking = 1keywords = herpesvirus (Clic here for more details about this article) |
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