Rapidly Progressive Multicentric Castleman's Disease in Patient with Acute Retroviral Syndrome: A Case Report

Multicentric Castleman’s Disease (MCD) is a lymphoproliferative disorder that happens more in Human Herpes Virus-8 (HHV-8) positive HIV patients. We are reporting a unique case of rapidly progressive Multicenteric Castleman’s disease in patient with acute retroviral syndrome. We are presenting a 40 year old male presented with fevers, chills and syncope. He was recently diagnosed with HIV. On presentation he was febrile. Physical examination demonstrated cervical lymphadenopathy with hepatosplenomegaly. His labs were significant for pancytopenia and hyponatremia. A working diagnosis of acute retroviral syndrome was made, although the anemia was too severe to be due to HIV only. He received blood transfusion, but the hemoglobin showed minimal improvement. CTAbdomen/pelvis was done and showed hepatosplenomegaly with enlarged lymph nodes. Lymph node biopsy was consistent with HHV-8 associated MCD. Accordingly, he was started on Anti-Retroviral Therapy for HIV and Gancyclovir and Rituxamab for MCD. Two days later, he continued to deteriorate and his blood counts dropped requiring multiple units of transfusion. Consequently, he developed severe respiratory distress, ventilated, and then he expired. In conclusion, we believe that occurrence of Castleman’s disease in acute HIVpatients before ART initiation is a poor prognostic sign and physicians should be aware of such entity