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Yamamoto A, Nishimori H, Shirai T, Takano K, Komura A, Kambara Y, Fukumi T, Urata T, Asada N, Ennishi D, Fujii K, Fujii N, Matsuoka KI, Niiya K, Suzuki-Inoue K, Maeda Y. Recurrent Cerebral Hemorrhaging with Platelet Dysfunction Accompanied by Anti-glycoprotein VI Autoantibodies in a Patient with TAFRO Syndrome. Intern Med 2024; 63:1917-1922. [PMID: 38945933 PMCID: PMC11272510 DOI: 10.2169/internalmedicine.2799-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/27/2023] [Indexed: 07/02/2024] Open
Abstract
Thrombocytopenia, anasarca, fever, renal dysfunction, and organomegaly (TAFRO) syndrome is an inflammatory disorder with an unclear pathogenesis. We herein report a case of TAFRO syndrome in remission in a patient who experienced recurrent intracranial bleeding despite a normal platelet count and coagulation system. A further investigation suggested the presence of anti-glycoprotein VI (GPVI) autoantibodies in the plasma, which induced platelet dysfunction and bleeding tendency. No new bleeding or relapse of TAFRO syndrome occurred after immunosuppressive therapy was initiated. These findings may help elucidate the autoimmune pathogenesis of TAFRO syndrome.
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Affiliation(s)
- Akira Yamamoto
- Department of Hematology and Oncology, Okayama University Hospital, Japan
| | - Hisakazu Nishimori
- Department of Hematology and Oncology, Okayama University Hospital, Japan
| | - Toshiaki Shirai
- Department of Clinical and Laboratory Medicine, University of Yamanashi, Japan
| | - Katsuhiro Takano
- Division of Transfusion Medicine and Cell Therapy, University of Yamanashi, Japan
| | - Aya Komura
- Department of Hematology, Okayama City Hospital, Japan
| | - Yui Kambara
- Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Takuya Fukumi
- Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Tomohiro Urata
- Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Noboru Asada
- Department of Hematology and Oncology, Okayama University Hospital, Japan
| | - Daisuke Ennishi
- Department of Hematology and Oncology, Okayama University Hospital, Japan
| | - Keiko Fujii
- Division of Clinical Laboratory, Okayama University Hospital, Japan
| | - Nobuharu Fujii
- Department of Hematology and Oncology, Okayama University Hospital, Japan
- Department of Blood Transfusion, Okayama University Hospital, Japan
| | - Ken-Ichi Matsuoka
- Department of Hematology and Oncology, Okayama University Hospital, Japan
| | | | - Katsue Suzuki-Inoue
- Department of Clinical and Laboratory Medicine, University of Yamanashi, Japan
| | - Yoshinobu Maeda
- Department of Hematology and Oncology, Okayama University Hospital, Japan
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Mimura Y, Kojima K, Fujikawa A, Okada S, Fujimori A, Kuma A, Kuragano T. A case of TAFRO syndrome after vaccination, successfully treated with cyclosporine. BMC Nephrol 2024; 25:196. [PMID: 38872134 PMCID: PMC11177486 DOI: 10.1186/s12882-024-03630-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 06/07/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND TAFRO syndrome is a rare disorder that causes thrombocytopenia, generalized oedema, fever, organ enlargement, and renal impairment. Few reports have suggested an association with vaccines, and few cases have undergone renal biopsy. TAFRO syndrome is often severe and fatal, and its cause is unknown. We report a case of TAFRO syndrome that occurred after vaccination with the coronavirus disease 2019 (COVID-19) vaccine. CASE PRESENTATION An 82-year-old woman received two doses of the BNT162b2 mRNA vaccine 3 weeks apart. Two weeks later, she was admitted to the hospital with oedema, accompanied with renal failure and thrombocytopenia. After close examination, she was diagnosed with TAFRO syndrome. She was treated with steroids, cyclosporine, and thrombopoietin receptor agonists. The patient was discharged after several months in remission. CONCLUSIONS Although an incident of TAFRO syndrome after COVID-19 vaccination has been previously reported, this is a rare case in which the patient went into remission and was discharged. A renal biopsy was also performed in this case, which was consistent with previous reports. The favorable treatment course for TAFRO syndrome provides valuable insights.
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Affiliation(s)
- Yasuyuki Mimura
- Department of Cardiovascular and Renal Medicine, Hyogo Medical University, 1-1 Mukogawa-Cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Katsuhito Kojima
- Department of Nephrology, Konan Medical Center, 1-5-16 Kamokogahara, Higashinada-Ku, Kobe, Hyogo, 658-0064, Japan
| | - Arisa Fujikawa
- Department of Nephrology, Konan Medical Center, 1-5-16 Kamokogahara, Higashinada-Ku, Kobe, Hyogo, 658-0064, Japan
| | - Shioko Okada
- Department of Nephrology, Konan Medical Center, 1-5-16 Kamokogahara, Higashinada-Ku, Kobe, Hyogo, 658-0064, Japan
| | - Akira Fujimori
- Department of Nephrology, Konan Medical Center, 1-5-16 Kamokogahara, Higashinada-Ku, Kobe, Hyogo, 658-0064, Japan
| | - Akihiro Kuma
- Department of Cardiovascular and Renal Medicine, Hyogo Medical University, 1-1 Mukogawa-Cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Takahiro Kuragano
- Department of Cardiovascular and Renal Medicine, Hyogo Medical University, 1-1 Mukogawa-Cho, Nishinomiya, Hyogo, 663-8501, Japan
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Sonoda K, Komatsu M, Ozawa Y, Yamamoto H, Kamijo Y. Investigation of the Effect of Therapeutic Plasma Exchange for TAFRO Syndrome: A Pilot Study. Biomedicines 2024; 12:849. [PMID: 38672203 PMCID: PMC11048432 DOI: 10.3390/biomedicines12040849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
TAFRO syndrome is a rare systemic inflammatory disorder with a fatal course. Nevertheless, a definitive treatment strategy has not yet been established. Anti-inflammatory therapies, including glucocorticoid treatment and immunosuppressants, have not been satisfactory. Therefore, new treatment options are needed for patients with TAFRO syndrome. The effectiveness of therapeutic plasma exchange (TPE) has mainly been reported in several case reports. In this case series study, we investigated the effect of TPE on TAFRO syndrome. We reviewed six consecutive cases with TAFRO syndrome treated at Shinshu University Hospital. All of them underwent TPE. A significant improvement in mean blood pressure, albumin, total bilirubin, and C-reactive protein was observed after TPE. Furthermore, early TPE treatment was suggested to have an impact on the prognosis. More intensive studies are needed to emphasize the overall conclusion obtained that TPE can be an effective/acceptable treatment option for TAFRO syndrome.
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Affiliation(s)
- Kosuke Sonoda
- Department of Nephrology, Shinshu University Hospital, Matsumoto 390-8621, Japan; (K.S.); (Y.K.)
| | - Masamichi Komatsu
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 390-8621, Japan; (Y.O.); (H.Y.)
| | - Yoko Ozawa
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 390-8621, Japan; (Y.O.); (H.Y.)
| | - Hiroshi Yamamoto
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 390-8621, Japan; (Y.O.); (H.Y.)
- Department of Respiratory Medicine, Iida Municipal Hospital, Iida 395-8502, Japan
| | - Yuji Kamijo
- Department of Nephrology, Shinshu University Hospital, Matsumoto 390-8621, Japan; (K.S.); (Y.K.)
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Chen T, Feng C, Zhang X, Zhou J. TAFRO syndrome: A disease that known is half cured. Hematol Oncol 2023; 41:310-322. [PMID: 36148768 DOI: 10.1002/hon.3075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/22/2022] [Accepted: 09/17/2022] [Indexed: 11/10/2022]
Abstract
Thrombocytopenia, anasarca, fever, reticulin fibrosis/renal failure, and organomegaly (TAFRO) syndrome is rare in clinical practice. It is a systemic inflammatory disease caused by a cytokine storm. Its clinical manifestations include thrombocytopenia, systemic edema, fever, bone marrow fibrosis, renal insufficiency, and organ enlargement. The high mortality rate of TAFRO syndrome is due to the difficulty of acquiring biopsy samples for diagnosis and the rapid disease progression. This disease is poorly understood by clinicians. Early detection, accurate diagnosis, and timely treatment play key roles in prolonging the survival of the patients. This review summarizes the latest progress in the pathogenesis, diagnostic criteria, and treatment regimens of TAFRO syndrome, aiming to help clinicians better understand TAFRO syndrome and improve its diagnosis and treatment.
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Affiliation(s)
- Tingting Chen
- Department of Hematology, The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
| | - Chun Feng
- Department of Hematology, The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- Department of Hematology, Shenzhen People's Hospital, Shenzhen, Guangdong, China
- The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Xinyou Zhang
- Department of Hematology, The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- Department of Hematology, Shenzhen People's Hospital, Shenzhen, Guangdong, China
- The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Jihao Zhou
- Department of Hematology, The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- Department of Hematology, Shenzhen People's Hospital, Shenzhen, Guangdong, China
- The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
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Nishimura Y, Nishikori A, Sawada H, Czech T, Otsuka Y, Nishimura MF, Mizuno H, Sawa N, Momose S, Ohsawa K, Otsuka F, Sato Y. Idiopathic multicentric Castleman disease with positive antiphospholipid antibody: atypical and undiagnosed autoimmune disease? J Clin Exp Hematop 2022; 62:99-105. [PMID: 35249898 PMCID: PMC9353850 DOI: 10.3960/jslrt.21038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Idiopathic multicentric Castleman disease (iMCD) is a systemic disorder characterized by systemic inflammation and organ dysfunction associated with an increase in pro-inflammatory cytokines. Some patients with iMCD are positive for autoantibodies, although their significance and relationship with specific associated autoimmune diseases are unclear. This study retrospectively analyzed the clinicopathological features of iMCD patients focusing on autoantibodies. Among 63 iMCD patients in our database, 19 were positive for at least one autoantibody. Among the 19, we identified five with plasma cell type (PC)-iMCD lymph node histopathology and positive anti-phospholipid antibodies. These patients were likely to have thrombocytopenia, anasarca, fever, reticulin fibrosis or renal insufficiency, organomegaly (TAFRO) symptoms, and thrombotic events. The present study suggests that patients with undiagnosed or atypical autoimmune diseases, including anti-phospholipid syndrome (APS), were treated for iMCD. APS may present with thrombocytopenia or even multi-organ failure, which overlap with clinical presentations of iMCD. Due to differences in the treatment regimen and follow-up, recognition of the undiagnosed autoimmune disease process in those suspected of iMCD is essential. Our study highlights the importance of complete exclusion of differential diagnoses in patients with iMCD in their diagnostic workup.
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Affiliation(s)
- Yoshito Nishimura
- Department of Medicine, University of Hawaii, Honolulu, HI, USA.,Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Asami Nishikori
- Division of Pathophysiology, Okayama University Graduate School of Health Sciences, Okayama, Japan
| | - Haruki Sawada
- Department of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Torrey Czech
- Department of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Yuki Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Midori Filiz Nishimura
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroki Mizuno
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Shuji Momose
- Department of Pathology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Kumiko Ohsawa
- Division of Pathophysiology, Okayama University Graduate School of Health Sciences, Okayama, Japan.,Department of Pathology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasuharu Sato
- Division of Pathophysiology, Okayama University Graduate School of Health Sciences, Okayama, Japan.,Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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Nishimura Y, Fajgenbaum DC, Pierson SK, Iwaki N, Nishikori A, Kawano M, Nakamura N, Izutsu K, Takeuchi K, Nishimura MF, Maeda Y, Otsuka F, Yoshizaki K, Oksenhendler E, Rhee F, Sato Y. Validated international definition of the thrombocytopenia, anasarca, fever, reticulin fibrosis, renal insufficiency, and organomegaly clinical subtype (TAFRO) of idiopathic multicentric Castleman disease. Am J Hematol 2021; 96:1241-1252. [PMID: 34265103 DOI: 10.1002/ajh.26292] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/03/2021] [Accepted: 07/10/2021] [Indexed: 12/11/2022]
Abstract
Thrombocytopenia, anasarca, fever, reticulin fibrosis, renal insufficiency, and organomegaly (TAFRO) syndrome is a heterogeneous entity manifesting with a constellation of symptoms described above that can occur in the context of idiopathic multicentric Castleman disease (iMCD) as well as infectious diseases, malignancies, and rheumatologic disorders. So, iMCD-TAFRO is an aggressive subtype of iMCD with TAFRO syndrome and often hyper-vascularized lymph nodes. Since we proposed diagnostic criteria of iMCD-TAFRO in 2016, we have accumulated new insights on the disorder and additional cases have been reported worldwide. In this systematic review and cohort analysis, we established and validated a definition for iMCD-TAFRO. First, we searched PubMed and Japan Medical Abstracts Society databases using the keyword "TAFRO" to extract cases. Patients with possible systemic autoimmune diseases and hematologic malignancies were excluded. Our search identified 54 cases from 50 articles. We classified cases into three categories: (1) iMCD-TAFRO (TAFRO syndrome with lymph node histopathology consistent with iMCD), (2) possible iMCD-TAFRO (TAFRO syndrome with no lymph node biopsy performed and no other co-morbidities), and (3) TAFRO without iMCD or other co-morbidities (TAFRO syndrome with lymph node histopathology not consistent with iMCD or other comorbidities). Based on the findings, we propose an international definition requiring four clinical criteria (thrombocytopenia, anasarca, fever/hyperinflammatory status, organomegaly), renal dysfunction or characteristic bone marrow findings, and lymph node features consistent with iMCD. The definition was validated with an external cohort (the ACCELERATE Natural History Registry). The present international definition will facilitate a more precise and comprehensive approach to the diagnosis of iMCD-TAFRO.
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Affiliation(s)
- Yoshito Nishimura
- Department of General Medicine Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
- Department of Medicine John A. Burns School of Medicine, University of Hawai'i Honolulu Hawaii USA
| | - David C. Fajgenbaum
- Center for Cytokine Storm Treatment & Laboratory, Division of Translational Medicine and Human Genetics Perelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania USA
| | - Sheila K. Pierson
- Center for Cytokine Storm Treatment & Laboratory, Division of Translational Medicine and Human Genetics Perelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania USA
| | - Noriko Iwaki
- Hematology/Respiratory Medicine Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Asami Nishikori
- Division of Pathophysiology Okayama University Graduate School of Health Sciences Okayama Japan
| | - Mitsuhiro Kawano
- Department of Rheumatology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Naoya Nakamura
- Department of Pathology Tokai University School of Medicine Isehara Japan
| | - Koji Izutsu
- Department of Hematology National Cancer Center Hospital Tokyo Japan
| | - Kengo Takeuchi
- Department of Pathology The Cancer Institute Hospital of Japanese Foundation for Cancer Research Tokyo Japan
- Division of Pathology Cancer Institute, Japanese Foundation for Cancer Research Tokyo Japan
- Pathology Project for Molecular Targets Cancer Institute, Japanese Foundation for Cancer Research Tokyo Japan
| | - Midori Filiz Nishimura
- Department of Pathology Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
| | - Yoshinobu Maeda
- Department of Hematology Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Fumio Otsuka
- Department of General Medicine Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
| | - Kazuyuki Yoshizaki
- Department of Organic Fine Chemicals Institute of Scientific and Industrial Research, Osaka University Osaka Japan
| | - Eric Oksenhendler
- Department of Clinical Immunology Hôpital Saint‐Louis Paris France
- Université de Paris Paris France
| | - Frits Rhee
- Myeloma Center University of Arkansas for Medical Sciences Little Rock Arkansas USA
| | - Yasuharu Sato
- Division of Pathophysiology Okayama University Graduate School of Health Sciences Okayama Japan
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Akagi Y, Kato T, Yamashita Y, Hosoi H, Murata S, Yamamoto S, Warigaya K, Nakao T, Murata S, Sonoki T, Tamura S. Intracranial Hemorrhage in a Patient with TAFRO Syndrome Treated with Cyclosporine A and Rituximab. ACTA ACUST UNITED AC 2021; 57:medicina57090971. [PMID: 34577894 PMCID: PMC8464675 DOI: 10.3390/medicina57090971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/16/2022]
Abstract
TAFRO syndrome, a rare subtype of idiopathic multicentric Castleman disease, manifests as thrombocytopenia, anasarca, fever, reticulin fibrosis, and organomegaly. Thrombotic microangiopathy, including renal dysfunction, is frequently associated with this syndrome. TAFRO syndrome can be life threatening and show rapid progression, and the diagnosis and management of this disorder remain challenging. A 48-year-old woman was diagnosed with TAFRO syndrome complicated by thrombotic microangiopathy based on the clinical and histopathological findings. After receiving high-dose steroids, her thrombocytopenia and anasarca did not improve. The patient subsequently received a combination of cyclosporine A and rituximab as second-line therapy, which resulted in a significant gradual improvement in the clinical symptoms. Meanwhile, her platelet count increased to more than 40 × 109/L; however, she developed intracranial hemorrhage. Following surgical evacuation, the patient recovered with an achievement of sustained remission. Based on these findings, attention should be paid to life-threatening bleeding associated with local thrombotic microangiopathy even when intensive treatment is administered for TAFRO syndrome.
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Affiliation(s)
- Yuina Akagi
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 6418509, Japan; (Y.A.); (T.K.); (Y.Y.); (H.H.); (S.M.); (T.S.)
- Department of Internal Medicine, Naga Municipal Hospital, Wakayama 6496414, Japan;
| | - Takashi Kato
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 6418509, Japan; (Y.A.); (T.K.); (Y.Y.); (H.H.); (S.M.); (T.S.)
| | - Yusuke Yamashita
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 6418509, Japan; (Y.A.); (T.K.); (Y.Y.); (H.H.); (S.M.); (T.S.)
- Department of Internal Medicine, Naga Municipal Hospital, Wakayama 6496414, Japan;
| | - Hiroki Hosoi
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 6418509, Japan; (Y.A.); (T.K.); (Y.Y.); (H.H.); (S.M.); (T.S.)
| | - Shogo Murata
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 6418509, Japan; (Y.A.); (T.K.); (Y.Y.); (H.H.); (S.M.); (T.S.)
| | - Shuto Yamamoto
- Department of Nephrology, Wakayama Medical University, Wakayama 6418509, Japan;
| | - Kenji Warigaya
- Department of Diagnostic Pathology, Wakayama Medical University, Wakayama 6418509, Japan; (K.W.); (S.M.)
| | - Taisei Nakao
- Department of Internal Medicine, Naga Municipal Hospital, Wakayama 6496414, Japan;
| | - Shinichi Murata
- Department of Diagnostic Pathology, Wakayama Medical University, Wakayama 6418509, Japan; (K.W.); (S.M.)
| | - Takashi Sonoki
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 6418509, Japan; (Y.A.); (T.K.); (Y.Y.); (H.H.); (S.M.); (T.S.)
| | - Shinobu Tamura
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 6418509, Japan; (Y.A.); (T.K.); (Y.Y.); (H.H.); (S.M.); (T.S.)
- Correspondence: ; Tel.: +81-73-441-0665; Fax: +81-73-441-0653
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Kawabata H, Fujimoto S, Sakai T, Yanagisawa H, Kitawaki T, Nara K, Hagihara M, Yamamoto H, Tanimizu M, Kato C, Origuchi T, Sunami K, Sunami Y, Masunari T, Nakamura N, Kobayashi M, Yamagami K, Miura K, Takai K, Aoki S, Tsukamoto N, Masaki Y. Patient's age and D-dimer levels predict the prognosis in patients with TAFRO syndrome. Int J Hematol 2021; 114:179-188. [PMID: 33929719 PMCID: PMC8085640 DOI: 10.1007/s12185-021-03159-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 11/26/2022]
Abstract
Objectives To identify prognostic factors for TAFRO syndrome, a rare inflammatory disorder of unknown etiology characterized by thrombocytopenia, anasarca, fever, reticulin myelofibrosis, renal dysfunction, and organomegaly. Methods Data of patients with TAFRO syndrome were extracted from a Japanese patient registry. Patients were divided into groups according to the clinical and laboratory parameters at initial presentation. Cut-off values for the laboratory parameters were determined using receiver operating characteristic curve analysis and by clinical relevance. Patient survival was analyzed by the Kaplan–Meier method. Univariable analysis was performed using log-rank tests. Multivariable analyses were performed with the logistic regression model and the Cox proportional hazards model. Results We extracted the data of 83 patients with TAFRO syndrome from the registry. Univariable analysis identified several potential prognostic factors. Of these factors, age ≥60 years and D-dimer ≥18 μg/dL remained significant predictors of poor overall survival in the multivariable Cox proportional hazards model. Based on these results, we developed a simple prognostic scoring system for TAFRO syndrome (TS-PSS). Conclusion Patients in our cohort were stratified into low, intermediate, and high-risk groups by the TS-PSS. This system should be verified with independent patient cohorts in future studies. Supplementary Information The online version contains supplementary material available at 10.1007/s12185-021-03159-x.
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Affiliation(s)
- Hiroshi Kawabata
- Department of Hematology and Immunology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa-ken, 920-0293, Japan.
| | - Shino Fujimoto
- Department of Hematology and Immunology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa-ken, 920-0293, Japan
| | - Tomoyuki Sakai
- Department of Hematology and Immunology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa-ken, 920-0293, Japan
| | - Hiroto Yanagisawa
- Department of Hematology and Immunology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa-ken, 920-0293, Japan
| | - Toshio Kitawaki
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenji Nara
- Department of Hematology, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Masao Hagihara
- Department of Hematology, Eiju General Hospital, Tokyo, Japan
| | - Hiroshi Yamamoto
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masakuni Tanimizu
- Department of Internal Medicine, Tottori Municipal Hospital, Tottori, Japan
| | - Chikako Kato
- Department of General Internal Medicine, Toyota Kosei Hospital, Toyota, Japan
| | - Tomoki Origuchi
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Kazutaka Sunami
- Department of Hematology, NHO Okayama Medical Center, Okayama, Japan
| | - Yoshitaka Sunami
- Department of Hematology, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Taro Masunari
- Department of Infectious Disease, Chugoku Central Hospital, Fukuyama, Japan
| | - Nobuhiko Nakamura
- Department of Hematology, Gifu University Graduate School of Medicine, Gifu, Japan
| | | | - Keiko Yamagami
- Department of Internal Medicine, Osaka City General Hospital, Osaka, Japan
| | - Katsuhiro Miura
- Division of Hematology and Rheumatology, Department of Internal Medicine, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Kazue Takai
- Department of Hematology, Niigata City General Hospital, Niigata, Japan
| | - Sadao Aoki
- Department of Pathophysiology, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences, Niigata, Japan
| | | | - Yasufumi Masaki
- Department of Hematology and Immunology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa-ken, 920-0293, Japan
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9
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Nishioka H, Nishino S, Yoshizaki A, Hara S. TAFRO syndrome presenting as intrahepatic cholangitis on autopsy. Clin Case Rep 2021; 9:2254-2258. [PMID: 33936675 PMCID: PMC8077398 DOI: 10.1002/ccr3.4005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 02/08/2021] [Accepted: 02/17/2021] [Indexed: 11/29/2022] Open
Abstract
Elevation of ALP is an abnormal feature in TAFRO syndrome, but the cause is unknown. This article is the first report that histologically showed intrahepatic cholangitis may be the cause of ALP elevation in TAFRO syndrome.
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Affiliation(s)
- Hiroaki Nishioka
- Department of General Internal MedicineKobe City Medical Center General HospitalKobeJapan
| | - Shogo Nishino
- Department of PathologyKobe City Medical Center General HospitalKobeJapan
| | - Aisa Yoshizaki
- Department of General Internal MedicineKobe City Medical Center General HospitalKobeJapan
| | - Shigeo Hara
- Department of PathologyKobe City Medical Center General HospitalKobeJapan
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10
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Sato T, Ono Y, Matsushima J, Fujii A, Sato Y, Hidaka Y, Kawamoto S, Yoshino A, Takeda T, Ueda Y, Ban S. Histopathologic findings of TAFRO syndrome with immunohistochemical analysis of the kidney specimen: A case report. HUMAN PATHOLOGY: CASE REPORTS 2021. [DOI: 10.1016/j.ehpc.2020.200471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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11
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Shimada K, Sasaki T, Okabe M, Koike K, Takahashi D, Terashima R, Honda Y, Matsumoto N, Fukui A, Ishikawa M, Tsuboi N, Yokoo T. TAFRO Syndrome With Kidney Involvement: A Case Series of Patients With Kidney Biopsies. Kidney Med 2021; 3:286-293. [PMID: 33851125 PMCID: PMC8039406 DOI: 10.1016/j.xkme.2020.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
TAFRO (thrombocytopenia, anasarca, fever, reticulin myelofibrosis/renal insufficiency, and organomegaly) syndrome is a systemic inflammatory disease sharing some features with Castleman disease and POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes) syndrome in relation to abnormal secretions of interleukin 6 and vascular endothelial growth factor. The kidney is a main target organ of TAFRO syndrome but the kidney histopathology associated with TAFRO syndrome is yet to be completely defined. We report 3 TAFRO syndrome cases with different clinical courses in which kidney biopsies were performed. In all 3 cases, kidney biopsies showed similar glomerular lesions of diffuse global swelling of the endothelium and expansion of subendothelial spaces, consistent with severe glomerular endothelial injury. Case 3 showed an additional finding of focal tubulointerstitial injury characterized by marked plasma cell infiltration, which was absent in the other 2 cases. Clinical symptoms in cases 1 and 2, which had lower disease severity scores of TAFRO syndrome, were effectively treated with the administration of corticosteroids or a combination of corticosteroids and cyclosporine A. Case 3, with a higher disease severity score, had an aggressive clinical course that was refractory to corticosteroids and tocilizumab; the patient ultimately died of multiple organ failure. In all 3 cases, kidney biopsy provided indications for the diagnosis process and clinical management of TAFRO syndrome.
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Affiliation(s)
- Keiki Shimada
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.,Department of Nephrology, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Takaya Sasaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.,Department of Nephrology, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Masahiro Okabe
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kentaro Koike
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Daisuke Takahashi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Risa Terashima
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yu Honda
- Department of Nephrology, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Naoto Matsumoto
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Akira Fukui
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Masahiro Ishikawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.,Department of Nephrology, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Nobuo Tsuboi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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12
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Fajgenbaum DC, Wu D, Goodman A, Wong R, Chadburn A, Nasta S, Srkalovic G, Mukherjee S, Leitch H, Jayanthan R, Ferrero S, Sato Y, Schey S, Dispenzieri A, Oksenhendler E, Zinzani PL, Lechowicz MJ, Hoffmann C, Pemmaraju N, Bagg A, Fossa A, Lim MS, Rhee F. Insufficient evidence exists to use histopathologic subtype to guide treatment of idiopathic multicentric Castleman disease. Am J Hematol 2020; 95:1553-1561. [PMID: 32894785 DOI: 10.1002/ajh.25992] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/17/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022]
Abstract
Idiopathic multicentric Castleman disease (iMCD) is a rare immunologic disorder characterized by systemic inflammation, multicentric lymphadenopathy, and organ dysfunction. Enlarged lymph nodes demonstrate a spectrum of characteristic but variable histopathologic features historically categorized into hyaline vascular (HV) (or hypervascular [HyperV] more recently), plasmacytic, or "mixed." Though the etiology is unknown, a pro-inflammatory cytokine storm, often involving interleukin-6 (IL-6), contributes to pathogenesis. Anti-IL-6 therapy with siltuximab is the only FDA- or EMA-approved treatment based on efficacy and safety in multiple studies. Importantly, no patients considered to have HV histopathology achieved the primary endpoint in the Phase II study. NCCN currently recommends siltuximab first-line for iMCD, except for patients considered to have HV histopathology. We investigated whether histopathologic subtype should guide siltuximab treatment decisions. Secondary analyses of clinical trial and real-world data revealed similar clinical benefit across histopathologic subtypes. Notably, only 18 of 79 patients in the Phase II study were consistently classified into histopathologic subtype by three independent review panels, demonstrating limited reliability to guide treatment decisions. Real-world data further demonstrate siltuximab's effectiveness in patients considered to have HV (or HyperV). Though histopathology is a critical component for diagnosis, there is insufficient evidence to guide treatment based solely on lymph node histopathologic subtype.
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Affiliation(s)
- David C. Fajgenbaum
- Division of Translational Medicine and Human Genetics, Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania
| | - David Wu
- Department of Laboratory Medicine University of Washington Seattle Washington
| | - Aaron Goodman
- Division of Blood and Marrow Transplantation UC San Diego Moores Cancer Center La Jolla California
| | - Raymond Wong
- Sir Y.K. Pao Centre for Cancer & Department of Medicine & Therapeutics Prince of Wales Hospital, The Chinese University of Hong Kong Sha Tin Hong Kong
| | - Amy Chadburn
- Department of Pathology and Laboratory Medicine Weill Cornell Medical College New York New York USA
| | - Sunita Nasta
- Division of Hematology/Oncology, Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
| | - Gordan Srkalovic
- Sparrow Cancer Center Edward W. Sparrow Hospital Association Lansing Michigan USA
| | - Sudipto Mukherjee
- Department of Hematology and Medical Oncology Cleveland Clinic Cleveland Ohio USA
| | - Heather Leitch
- Division of Hematology University of British Columbia Vancouver British Columbia Canada
| | - Raj Jayanthan
- Department of Pediatrics Montefiore Medical Center Bronx New York USA
| | - Simone Ferrero
- Division of Hematology University of Torino Torino Italy
| | - Yasuharu Sato
- Department of Pathology Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
| | - Steve Schey
- Department of Haematological Medicine, Kings' College London University London UK
| | | | | | | | - Mary Jo Lechowicz
- Department of Hematology and Medical Oncology Emory University School of Medicine Atlanta Georgia
| | | | | | - Adam Bagg
- Department of Pathology & Laboratory Medicine, Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania
| | - Alexander Fossa
- Department of Oncology Oslo University Hospital – Norwegian Radium Hospital Oslo Norway
| | - Megan S. Lim
- Department of Pathology & Laboratory Medicine, Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania
| | - Frits Rhee
- Myeloma Center University of Arkansas for Medical Sciences Little Rock Arkansas
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13
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Minamikawa S, Matsumura O, Sato S, Nakagishi Y, Tanaka R. A pediatric case of tocilizumab-resistant TAFRO syndrome treated successfully with rituximab. Pediatr Blood Cancer 2020; 67:e28489. [PMID: 32568456 DOI: 10.1002/pbc.28489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/17/2020] [Accepted: 05/24/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Shogo Minamikawa
- Department of General Pediatrics, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan.,Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Osamu Matsumura
- Department of General Pediatrics, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Seiko Sato
- Department of General Pediatrics, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Yasuo Nakagishi
- Department of General Pediatrics, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Ryojiro Tanaka
- Department of General Pediatrics, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
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14
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Zhou Q, Zhang Y, Zhou G, Zhu J. Kidney biopsy findings in two patients with TAFRO syndrome: case presentations and review of the literature. BMC Nephrol 2020; 21:499. [PMID: 33225930 PMCID: PMC7682079 DOI: 10.1186/s12882-020-02119-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 10/21/2020] [Indexed: 01/09/2023] Open
Abstract
Background TAFRO syndrome is a clinical subtype of idiopathic multicentric Castleman disease (iMCD) that is characterized by thrombocytopenia, anasarca, fever, reticulin myelofibrosis (or renal dysfunction), and organomegaly. TAFRO syndrome has only recently been described, and many clinicians are unaware of this disease, leading to delays in diagnosis and treatment. We present two patients with TAFRO syndrome in whom renal biopsies were performed. Case presentation Both patients had subacute onset and exhibited renal insufficiency, edema, anemia, thrombocytopenia, polyserositis and lymphadenopathy over the disease course. However, there were many differences in their clinical manifestations. Case 1 was a 30-year-old woman admitted due to intermittent vaginal bleeding for 3 weeks. Laboratory tests on admission showed severe renal insufficiency (creatinine: 624 μmol/L), severe anemia (Hb: 41 g/L), and moderate thrombocytopenia (61 × 109/L). Case 2 was a 42-year-old man. Acute epigastric pain was his initial complaint, and computed tomography (CT) revealed retroperitoneal exudation around the pancreas. He was diagnosed with acute pancreatitis, and after treatment with a proton pump inhibitor (PPI) and somatostatin, his abdominal pain still recurred. During treatment, renal failure gradually increased, with oliguria, fever, anemia, thrombocytopenia, edema and massive ascites. Lymph node histologies were consistent with the hyaline-vascular (HV) type and mixed type, respectively, and renal histopathologies were consistent with thrombotic microangiopathy (TMA)-like renal lesions and membranoproliferative glomerulonephritis (MPGN), respectively. Their general conditions improved after glucocorticoid therapy, but their renal functions did not recover completely. On the basis of glucocorticoids, second-line treatments with tocilizumab and rituximab, respectively, were applied. Conclusions The diagnosis of TAFRO syndrome is based mainly on clinical manifestations and lymph node biopsies. A reliable early diagnosis and appropriate rapid treatment are essential to improve patient outcomes. Clinicians should deepen their understanding of this disease and similar conditions. Once the disease is suspected, lymph node biopsies should be performed as soon as possible. In addition, renal biopsies should be actively performed in patients with renal involvement.
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Affiliation(s)
- Qianyun Zhou
- Intensive Care Unit Peking University Shougang Hospital, Beijing, China. .,Department of Emergency, Peking University People's Hospital, Beijing, China.
| | - Yuanyuan Zhang
- Department of Emergency, Peking University People's Hospital, Beijing, China
| | - Guangping Zhou
- Department of Emergency, Peking University People's Hospital, Beijing, China
| | - Jihong Zhu
- Department of Emergency, Peking University People's Hospital, Beijing, China
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15
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Kadoba K, Waki D, Nishimura K, Mukoyama H, Saito R, Murabe H, Yokota T. Development of severe thrombocytopenia with TAFRO syndrome-like features in a patient with rheumatoid arthritis treated with a Janus kinase inhibitor: A case report. Medicine (Baltimore) 2020; 99:e22793. [PMID: 33080751 PMCID: PMC7571883 DOI: 10.1097/md.0000000000022793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
RATIONALE Thrombocytepenia, anasarca, fever, renal insufficiency, and organomegaly (TAFRO) syndrome is a novel disease entity characterized by a constellation of symptoms (thrombocytopenia, anasarca, fever, renal insufficiency, and organomegaly). Here, we describe the development of TAFRO syndrome-like features during the treatment of rheumatoid arthritis with a Janus kinase (JAK) inhibitor. PATIENT CONCERNS In this report, a 74-year-old woman treated with a JAK inhibitor (tofacitinib) for rheumatoid arthritis was admitted because of fever and thrombocytopenia. DIAGNOSES On laboratory examination, marked thrombocytopenia and elevated creatinine and C-reactive protein levels were present. A computed tomography scan revealed lymphadenopathy, hepato-splenomegaly, and anasarca. A left axillary lymph node biopsy revealed Castleman's disease-like features. These clinical features satisfied the proposed diagnostic criteria for TAFRO syndrome. Since autoimmune disorders should be excluded when diagnosing TAFRO syndrome, it is not strictly correct to diagnose her as TAFRO syndrome. Therefore, we diagnosed her as rheumatoid arthritis complicated by TAFRO syndrome-like features. INTERVENTIONS The patient was treated with high-dose glucocorticoid, tacrolimus, eltrombopag, intravenous immunoglobulin, and rituximab. OUTCOMES Her condition was refractory to the above-mentioned treatment, and she eventually died because of multi-organ failure 6 months after the first admission. LESSONS TAFRO syndrome-like features can develop during treatment with a JAK inhibitor for rheumatoid arthritis. Patients with autoimmune diseases complicated by TAFRO syndrome-like features can follow a fatal clinical course, and thus, an intensive combined treatment is warranted for such patients, especially in cases refractory to glucocorticoid.
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16
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Tocilizumab for the treatment of TAFRO syndrome: a systematic literature review. Ann Hematol 2020; 99:2463-2475. [DOI: 10.1007/s00277-020-04275-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/17/2020] [Indexed: 02/07/2023]
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17
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Wu YJ, Su KY. Updates on the diagnosis and management of multicentric Castleman disease. Tzu Chi Med J 2020; 33:22-28. [PMID: 33505874 PMCID: PMC7821823 DOI: 10.4103/tcmj.tcmj_15_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/13/2020] [Accepted: 04/27/2020] [Indexed: 12/28/2022] Open
Abstract
Multicentric Castleman disease (MCD) is an uncommon systemic lymphoproliferative disease. The diagnosis of this disease is typically challenging and requires collaboration between clinicians and pathologists. Moreover, it is important to exclude other diseases (such as malignancies, autoimmune diseases, and infectious diseases) that have similar clinical manifestations and pathological findings. Patients with untreated severe MCD have high mortality due to devastating cytokine storms. Thus, early diagnosis and prompt treatment is a key imperative. The diagnosis of MCD is based on the clinical signs of systemic inflammation, serological tests, and typical pathological features. In this review article, we provide an overview of MCD with a focus on the emerging evidence pertaining to its diagnosis and treatment.
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Affiliation(s)
- Ya-Ju Wu
- Division of Critical Care Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Kuei-Ying Su
- Division of Rheumatology and Immunology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
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18
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Yamaguchi Y, Maeda Y, Shibahara T, Nameki S, Nakabayashi A, Komuta K, Mizuno Y, Yagita M, Manabe Y, Morita T, Nishide M, Watanabe A, Takamatsu H, Nishida S, Hirano T, Shima Y, Narazaki M, Kumanogoh A. Recovery from prolonged thrombocytopenia in patients with TAFRO syndrome: case series and literature review. Mod Rheumatol Case Rep 2020; 4:302-309. [PMID: 33087016 DOI: 10.1080/24725625.2020.1717747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
TAFRO syndrome is a newly proposed disease that is characterised by thrombocytopenia, anasarca, fever, reticulin fibrosis (or renal dysfunction), and organomegaly. Generally, high doses of corticosteroids are recommended for the initial treatment of TAFRO syndrome; however, some patients experience prolonged refractory thrombocytopenia after initiating such therapies. If corticosteroid treatment alone is ineffective, additional immunosuppressive therapies such as cyclosporine A are recommended. Since long-term use of immunosuppressive therapies with TAFRO syndrome sometimes causes serious infection, it is important to recognise the time to recovery from thrombocytopenia. In this study, we investigated how long it took to recover from thrombocytopenia, to aid clinicians in decision-making regarding the need to strengthen treatment for prolonged thrombocytopenia. Here, we describe three of our patients with TAFRO syndrome exhibiting prolonged thrombocytopenia. We also investigated the median period to recovery from this complication (defined as the time to increase the platelet count above 50,000/µL) after the initiation of high-dose corticosteroid treatment in our 3 cases and 38 peer-reviewed cases. We found that it took our patients 61 days to recover from thrombocytopenia; in comparison, our investigation of the 38 peer-reviewed case reports revealed a median recovery time of 47.5 days among previously reported patients. We showed the time to recovery from thrombocytopenia in patients with TAFRO syndrome for the first time. Our findings ought to be useful for decision-making among clinicians regarding the administration of other immunosuppressive treatments in addition to corticosteroid.
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Affiliation(s)
- Yuta Yamaguchi
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuichi Maeda
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takayuki Shibahara
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shinichiro Nameki
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Akihiko Nakabayashi
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kiyohide Komuta
- Postgraduate Medical Training Center, Osaka University Medical Hospital, Osaka, Japan
| | - Yumiko Mizuno
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Mayu Yagita
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yusuke Manabe
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takayoshi Morita
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Masayuki Nishide
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Akane Watanabe
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan.,Thermo-Therapeutics for Vascular Dysfunction, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hyota Takamatsu
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Sumiyuki Nishida
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Toru Hirano
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yoshihito Shima
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan.,Thermo-Therapeutics for Vascular Dysfunction, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Masashi Narazaki
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Atsushi Kumanogoh
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
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19
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Xia P, Zhang L, Zou M, Zhang T, Li R, Shi X, Wang J, Qin Y, Li X, Li J, Chen L. Acute Kidney Injury Caused by TAFRO Syndrome in a Chinese Patient: Efficacy of Long-Term Corticosteroids Combined with Bortezomib and Cyclophosphamide. Kidney Blood Press Res 2020; 45:623-630. [PMID: 32492687 DOI: 10.1159/000505458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/15/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Thrombocytopenia, ascites, myelofibrosis, renal dysfunction, and organomegaly (TAFRO) syndrome is a newly recognized and rare clinical subtype of Castleman disease. Renal involvement in TAFRO syndrome usually presents with mild proteinuria, microscopic hematuria, and acute renal injury requiring temporary renal replacement. There is no standard therapy available and treatment failures are common, leading to a poor prognosis. We report a case of acute renal failure caused by TAFRO syndrome, successfully managed by long-term corticosteroids combined with bortezomib and cyclophosphamide. CASE PRESENTATION The patient was a 52-year-old female who presented with fever, anasarca, oliguria, and abdominal distension at first. She progressed rapidly to anuric renal failure requiring hemodialysis. She also demonstrated thrombocytopenia, anemia, coagulopathy, and a hyperinflammatory status. Her CT scan showed severe polyserositis, splenomegaly, and lymphadenopathy. Her serum vascular epithelial growth factor level was significantly elevated. Axillary lymph node biopsy showed hyaline-vascular type Castleman disease, supporting the diagnosis of TAFRO syndrome. Her renal function recovered after high-dose steroids and supportive treatment. A weekly dosing regimen of bortezomib, cyclophosphamide, and dexamethasone combined with medium dose prednisone in between were deployed. Her blood cell count and renal function remained stable after 6 months. The inflammation was suppressed and the polyserositis resolved completely. CONCLUSION TAFRO syndrome is rare and has a poor prognosis due to the lack of standard treatment. Our patient might be the first TAFRO case successfully treated by bortezomib, cyclophosphamide, and corticosteroids.
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Affiliation(s)
- Peng Xia
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lu Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Menglian Zou
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Tengyue Zhang
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ran Li
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoxiao Shi
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Wang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Qin
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xuemei Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jian Li
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Limeng Chen
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China,
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20
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Computed tomography findings of early-stage TAFRO syndrome and associated adrenal abnormalities. Eur Radiol 2020; 30:5588-5598. [PMID: 32440781 DOI: 10.1007/s00330-020-06919-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/22/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To compare CT findings of early (within 3 weeks post-onset)- and later (within 1 month before or after diagnostic criteria were satisfied, and later than 3 weeks post-onset) stage thrombocytopenia, anasarca, fever, reticulin fibrosis, renal dysfunction, and organomegaly (TAFRO) syndrome. METHODS Between 2014 and 2019, 13 patients with TAFRO syndrome (8 men and 5 women; mean age, 54.9 years) from nine hospitals were enrolled. The number of the following CT findings (CT factors) was recorded: the presence of anasarca, organomegaly, adrenal ischaemia, anterior mediastinal lesion, bony lesion, and lymphadenopathy. Records of adrenal disorders (adrenomegaly, ischaemia, and haemorrhage) throughout the disease course were also collected. Differences in CT factors at each stage were statistically compared between remission and deceased groups. RESULTS Para-aortic oedema and mild lymphadenopathy were observed in all patients, whereas pleural effusion, ascites, and subcutaneous oedema were found in 5/13, 7/13, and 7/13 cases, respectively, at the early stage. CT factors at the early stage were significantly higher in the deceased than in the remission group (mean, 11 vs 6.5; p = 0.04), while they were nonsignificant at the later stage. Adrenal disorders were present in 7/13 cases throughout the course including 6 of adrenomegaly and 4 of ischaemia at the early stage. CONCLUSIONS Para-aortic oedema and mild lymphadenopathy are most common at the early stage. Anasarca, organomegaly, lymphadenopathy, and adrenal disorders on early-stage CT are useful for unfavourable prognosis prediction. Moreover, adrenal disorders are frequent even at the early stage and are useful for early diagnosis of TAFRO syndrome. KEY POINTS • CT findings facilitate early diagnosis and prognosis prediction in TAFRO syndrome. • Adrenal disorders are frequently observed in TAFRO syndrome. • Adrenal disorders are useful for differential diagnosis of TAFRO syndrome.
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21
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Mizuno H, Sawa N, Watanabe S, Ikuma D, Sekine A, Kawada M, Yamanouchi M, Hasegawa E, Suwabe T, Hoshino J, Takaichi K, Kinowaki K, Fujii T, Ohashi K, Nagata M, Yamaguchi Y, Ubara Y. The Clinical and Histopathological Feature of Renal Manifestation of TAFRO Syndrome. Kidney Int Rep 2020; 5:1172-1179. [PMID: 32775816 PMCID: PMC7403508 DOI: 10.1016/j.ekir.2020.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/30/2020] [Accepted: 05/07/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction Thrombocytopenia, anasarca, myelofibrosis, renal dysfunction, and organomegaly (TAFRO) syndrome is a severe subtype of idiopathic multicentric Castleman’s disease, characterized by thrombocytopenia, anasarca, fever, reticulin myelofibrosis, and organomegaly. Renal complication of this disease can be life-threatening and sometimes requires hemodialysis, but it has not been elucidated in detail. Methods Case-series was designed to evaluate the renal histology of patients with TAFRO syndrome treated at our hospital. Results Seven patients were eligible to the criteria. All of them had severe diuretic-resistant anasarca and 6 of 7 had mild proteinuria (<1 g daily). On light microscopy, all patients showed glomerular endotheliopathy characterized by endothelial cell swelling and a double contour of the glomerular basement membrane with mesangiolysis or mesangial loosening. Immunofluorescent staining and electron microscopy did not detect immune deposits in any patient. Electron microscopy revealed endothelial cell swelling with diffuse expansion of the subendothelial space, loss of mesangial architecture, and loss of endothelial cell fenestrations. Treatment with glucocorticoids and molecular-targeting agents, including tocilizumab and rituximab, improved renal dysfunction and anasarca. In 4 of 7 patients with persistent thrombocytopenia, hemorrhagic events occurred despite platelet transfusion or thrombopoietin receptor antagonist therapy. Conclusion Severe diuretic-resistant anasarca with mild proteinuria and severe glomerular endotheliopathy were common characteristics of renal dysfunction due to TAFRO syndrome. In addition, endothelial changes mediated via interleukin (IL)-6 and vascular endothelial growth factor (VEGF) that lead to vascular hyperpermeability and water leakage might contribute to anasarca, because molecular-targeting therapy directed against IL-6 or VEGF improved renal dysfunction and severe endothelial damage.
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Affiliation(s)
- Hiroki Mizuno
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
- Correspondence: Hiroki Mizuno, Nephrology Center, Toranomon Hospital, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, Japan.
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | | | | | | | | | | | | | | | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Kenmei Takaichi
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | | | - Takeshi Fujii
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
- Department of Pathology, Hospital of Yokohama City University, Yokohama, Kanagawa, Japan
| | - Michio Nagata
- Department of Kidney and Vascular Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | | | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
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22
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Nunes MB, Rotman S, Duss FR, Halfon M. HHV-8-negative multicentric Castleman disease presenting as a crescentic immune complexes membranoproliferative glomerulonephritis. BMJ Case Rep 2020; 13:13/1/e231844. [PMID: 31911409 PMCID: PMC6954780 DOI: 10.1136/bcr-2019-231844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Multicentric Castleman disease is a rare polyclonal lymphoproliferative disorder mainly associated with two renal manifestations: thrombotic microangiopathy and amyloidosis. Nevertheless, we report here a case of human herpes virus-8 negative multicentric Castleman disease with membranous proliferative glomerulonephritis and extracapillary proliferation. A patient was successfully treated with corticosteroids, anti-CD20 and cyclophosphamide therapy.
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Affiliation(s)
- Maria Brito Nunes
- Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Samuel Rotman
- Institute of Pathology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Francois-Regis Duss
- Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Matthieu Halfon
- Nephrology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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23
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Nagayama Y, Yamano M, Yagame M, Nariyama T, Takahashi M, Kawamoto M, Matsui K. TAFRO syndrome as a cause of glomerular microangiopathy: a case report and literature review. BMC Nephrol 2019; 20:375. [PMID: 31623576 PMCID: PMC6798393 DOI: 10.1186/s12882-019-1574-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 09/30/2019] [Indexed: 12/31/2022] Open
Abstract
Background TAFRO syndrome is a systemic inflammatory disorder that manifests as thrombocytopenia (T), anasarca (A), fever (F), reticulin fibrosis (R), and organomegaly (O). Renal dysfunction is frequently complicated with TAFRO syndrome, however, it is challenging to perform kidney biopsy in patients with TAFRO syndrome in the presence of thrombocytopenia. Renal histology in TAFRO syndrome mainly shows membranoproliferative glomerulonephritis (MPGN)-like lesions or thrombotic microangiopathy (TMA)-like glomerulopathy. We review our case and previous reports of TAFRO syndrome with kidney biopsy findings and discuss the renal pathophysiology of TAFRO syndrome. Case presentation We describe a previously healthy 48- year-old woman with TAFRO syndrome. Kidney biopsy performed before the treatment showed diffuse global endocapillary proliferative changes with endothelial cell swelling, double contours of partial capillary walls, and mesangiolysis, consistent with TMA-like glomerulopathy. Glucocorticoid therapy including steroid pulse was ineffective and she developed anasarca, renal dysfunction and oliguria. Hemodialysis was required. However, the anti-Interleukin (IL)-6 receptor antibody (tocilizumab) therapy was very effective. An increase in urinary volume was achieved about 2 weeks after the tocilizumab therapy and hemodialysis was discontinued. To investigate the renal pathophysiology of TAFRO syndrome, we performed immunohistological staining of vascular endothelial growth factor (VEGF)-A, CD34, and D2–40, in our case and a normal control kidney. Glomerular VEGF-A was especially positive in podocytes both, in the control and in the case, with no significant difference and there was a significant increase of VEGF-A staining area in the cortical peritubular capillaries in the case. Both glomerular and renal cortical CD34 expression were significantly decreased in our case. D2–40 expression in cortex was not significantly different. Conclusions We reviewed our case and other 10 previous reports about renal biopsy findings in TAFRO syndrome and found that glomerular microangiopathy was a common finding. IL-6-VEGF-axis-induced glomerular microangiopathy may play a crucial role in developing acute kidney injury in TAFRO syndrome and the anti-IL-6 receptor antibody therapy may be useful for TAFRO syndrome refractory to glucocorticoids. About the pathophysiology of VEGF in TAFRO syndrome, VEGF balance in the glomerulus and perhaps in the peritubular capillary system as well may be critical. Further investigation is needed.
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Affiliation(s)
- Yoshikuni Nagayama
- Department of Internal Medicine IV, Teikyo University School of medicine, University Hospital, Mizonokuchi, Kawasaki, Japan.
| | - Mizuki Yamano
- Department of Internal Medicine IV, Teikyo University School of medicine, University Hospital, Mizonokuchi, Kawasaki, Japan
| | - Motoka Yagame
- Department of Internal Medicine IV, Teikyo University School of medicine, University Hospital, Mizonokuchi, Kawasaki, Japan
| | - Tomoyuki Nariyama
- Department of Internal Medicine IV, Teikyo University School of medicine, University Hospital, Mizonokuchi, Kawasaki, Japan
| | - Mikiko Takahashi
- Department of Diagnostic Pathology, Teikyo University School of medicine, University Hospital, Mizonokuchi, Kawasaki, Japan
| | - Masashi Kawamoto
- Department of Diagnostic Pathology, Teikyo University School of medicine, University Hospital, Mizonokuchi, Kawasaki, Japan
| | - Katsuyuki Matsui
- Department of Internal Medicine IV, Teikyo University School of medicine, University Hospital, Mizonokuchi, Kawasaki, Japan
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24
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Leurs A, Gnemmi V, Lionet A, Renaud L, Gibier JB, Copin MC, Hachulla E, Hatron PY, Launay D, Fajgenbaum D, Terriou L. Renal Pathologic Findings in TAFRO Syndrome: Is There a Continuum Between Thrombotic Microangiopathy and Membranoproliferative Glomerulonephritis? A Case Report and Literature Review. Front Immunol 2019; 10:1489. [PMID: 31316523 PMCID: PMC6609882 DOI: 10.3389/fimmu.2019.01489] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 06/14/2019] [Indexed: 12/23/2022] Open
Abstract
Background: TAFRO syndrome is a clinical subtype of idiopathic multicentric Castleman disease (iMCD) that is characterized by thrombocytopenia, anasarca, fever and/or elevated serum C-reactive protein, renal dysfunction, and organomegaly. Case Presentation: A 28-year-old woman with fever, weight gain of 13 kgs, lower extremity edema, hepatosplenomegaly, and multicentric peripheral lymphadenopathy was referred to our center. Laboratory investigations revealed anemia, thrombocytopenia, creatinine at 1.19 mg/dL and hypoalbuminemia at 33 g/L. Proteinuria was measured at 2 g/day including albuminuria at 1.5 g/day. Urinary sediment examination found leukocyturia at 44,000/mL and hematuria at 645,000/mL. Vascular endothelial growth factor (VEGF) level was elevated. A cervical lymph node biopsy found features consistent with the mixed histopathological subtype of iMCD. A renal biopsy revealed a membranoproliferative glomerulonephritis (MPGN) pattern. We initiated 3 days of methylprednisolone pulse-therapy at 1,000 mg per day, followed by prednisone 1 mg/kg/day and evolution was favorable. Review of Literature: 19 iMCD patients with TAFRO syndrome had undergone a renal biopsy: 8 cases with author's diagnosis consistent with MPGN-like and 11 cases of thrombotic microangiopathy (TMA)-like glomerulopathy without fibrin thrombi in glomerular capillaries or arterioles and without typical biological signs. Clinical, biological, and outcome characteristics were similar between the cases described as having MPGN and TMA-like presentation. After a thorough review of histopathological descriptions for each case, MPGN lesions seems to be the consequences of chronic glomerular endothelial injury in persistent TMA. We suspect that VEGF and IL-6 play a key role in the physiopathology of the spectrum of renal involvement from TMA-like to MPGN observed in TAFRO syndrome. Conclusion: We present a Caucasian iMCD patient with TAFRO syndrome with renal insufficiency secondary to MPGN, which might be secondary to a chronic TMA-like disease. We suspect that there is a continuum between TMA and MPGN lesions in TAFRO syndrome favored by VEGF and IL-6.
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Affiliation(s)
- Amélie Leurs
- Département de Médecine Interne et Immunologie Clinique, CHU Lille, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), LIRIC INSERM U995, Université de Lille, Lille, France.,CHU Lille, Institut d'Immunologie, Université de Lille, Lille, France
| | - Viviane Gnemmi
- Département d'Anatomo-Cyto-Pathologie, CHU Lille, Centre de Biologie Pathologie, Université de Lille, Lille, France
| | - Arnaud Lionet
- Département de Néphrologie, CHU Lille, Université de Lille, Lille, France
| | - Loïc Renaud
- CHU Lille, Institut d'Immunologie, Université de Lille, Lille, France.,Département des Maladies du Sang, CHU Lille, Université de Lille, Lille, France
| | - Jean-Baptiste Gibier
- Département d'Anatomo-Cyto-Pathologie, CHU Lille, Centre de Biologie Pathologie, Université de Lille, Lille, France
| | - Marie-Christine Copin
- Département d'Anatomo-Cyto-Pathologie, CHU Lille, Centre de Biologie Pathologie, Université de Lille, Lille, France
| | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, CHU Lille, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), LIRIC INSERM U995, Université de Lille, Lille, France
| | - Pierre-Yves Hatron
- Département de Médecine Interne et Immunologie Clinique, CHU Lille, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), LIRIC INSERM U995, Université de Lille, Lille, France
| | - David Launay
- Département de Médecine Interne et Immunologie Clinique, CHU Lille, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), LIRIC INSERM U995, Université de Lille, Lille, France.,CHU Lille, Institut d'Immunologie, Université de Lille, Lille, France
| | - David Fajgenbaum
- Department of Translational Medicine and Human Genetics, University of Pennsylvania, Philadelphia, PA, United States
| | - Louis Terriou
- Département de Médecine Interne et Immunologie Clinique, CHU Lille, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), LIRIC INSERM U995, Université de Lille, Lille, France.,CHU Lille, Institut d'Immunologie, Université de Lille, Lille, France
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25
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Hashimoto K, Sano T, Honma Y, Ida M, Tominaga H, Sawada A, Abe T, Takahashi H, Shimada Y, Masaki T, Kamata M, Naito S, Aoyama T, Takeuchi Y, Akiya M, Inukai M, Nakata N. An autopsy case of TAFRO syndrome with membranoproliferative glomerulonephritis-like lesions. CEN Case Rep 2018; 8:48-54. [PMID: 30244358 DOI: 10.1007/s13730-018-0363-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 09/09/2018] [Indexed: 12/21/2022] Open
Abstract
TAFRO syndrome (thrombocytopenia, anasarca, myelofibrosis, renal dysfunction, and organomegaly) is an atypical manifestation of multicentric Castleman's disease. Although overproduction of interleukin-6, vascular endothelial growth factor, and other cytokines may partially explain the pathophysiology of this rare syndrome, the precise mechanisms underlying the renal dysfunction associated with the condition remain unclear. Here, we describe a case of a 69-year-old male with TAFRO syndrome. He was treated with immunosuppressive agents and his renal function improved. Tapering of immunosuppressive agents resulted in a deterioration of renal function and an elevation of C-reactive protein. After 20 months of treatment, the patient died from tuberculous peritonitis and gastrointestinal bleeding. An autopsy revealed miliary tuberculosis, mediastinal lymphadenopathy, and gastric ulcers. Renal histopathology showed a membranoproliferative glomerulonephritis-like appearance. Almost all glomeruli showed lobular formations with mesangial proliferation and duplication of glomerular capillary walls on light microscopy. Immunofluorescence showed deposition of C1q and IgM along the glomerular capillary walls. Electron microscopy showed mesangial expansion and widening of the subendothelial space with a large number of electron-dense deposits. The glomerular lesions might be characteristic of TAFRO syndrome, and were regarded as the main cause of the patient's renal dysfunction.
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Affiliation(s)
- Keiko Hashimoto
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takashi Sano
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan.
| | - Yukari Honma
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Maoko Ida
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroshi Tominaga
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Aya Sawada
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tetsuya Abe
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Haruka Takahashi
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yoshitaka Shimada
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takanori Masaki
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Mariko Kamata
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Shokichi Naito
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Togo Aoyama
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yasuo Takeuchi
- Department of Nephrology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masashi Akiya
- Department of Pathology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Madoka Inukai
- Department of Pathology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Norihiro Nakata
- Department of Pathology, Kitasato University School of Medicine, Sagamihara, Japan
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