Treatment consistent with idiopathic multicentric Castleman disease guidelines is associated with improved outcomes

Castleman Disease-Still More Questions than Answers: A Case Report and Review of the Literature

Background: Idiopathic multicentric Castleman disease (iMCD) is a rare lymphoproliferative disorder with diverse clinical presentations, often posing significant diagnostic challenges. Methods: We report the case of a 20-year-old woman who first presented with fever of unknown origin (FUO) at the age of 14, followed by the development of abdominal lymphadenopathy. We conducted a comprehensive review of her clinical course, diagnostic workup, treatment response, and outcomes. Additionally, we performed a literature review of CD focusing on pathophysiology, classification, diagnostic approaches, and treatment strategies. Results: Extensive investigations performed in the meantime excluded infectious and autoimmune causes. Histopathological analysis of the excised lymph nodes ruled out malignancy and confirmed idiopathic multicentric Castleman disease. Treatment with tocilizumab, an IL-6 receptor antagonist, resulted in rapid resolution of clinical symptoms, normalization of inflammatory markers, and sustained remission. With the final diagnosis established and treatment initiated, she was transitioned at the age of 18 from a pediatric immunology to an adult clinical immunology center. Conclusions: The presented case highlights the importance of considering iMCD in the differential diagnosis of FUO, especially in adolescents, and the efficacy of targeted therapies in managing this challenging disease. A multidisciplinary approach involving clinical, laboratory, imaging, and histopathological evaluation is essential for accurate diagnosis. IL-6 pathway inhibition represents an effective targeted therapy for iMCD, capable of inducing sustained remission in this challenging disease.

Nanotechnology for controlling mango malformation: a promising approach

Mango (Mangifera indica L.) is one of the most important fruit crops in the world with yields of approximately 40 million tons annually and its production continues to decrease every year as a result of the attack of certain pathogens i.e. Colletotrichum gloeosporioides, Erythricium salmonicolor, Amritodus atkinsoni, Idioscopus clypealis, Idioscopus nitidulus, Bactrocera obliqua, Bactrocera frauenfeldi, Xanthomonas campestris, and Fusarium mangiferae. So F. mangiferae is the most harmful pathogen that causes mango malformation disease in mango which decreases its 90% yield. Nanotechnology is an eco-friendly and has a promising effect over traditional methods to cure fungal diseases. Different nanoparticles possess antifungal potential in terms of controlling the fungal diseases in plants but applications of nanotechnology in plant disease managements is minimal. The main focus of this review is to highlight the previous and current strategies to control mango malformation and highlights the promising applications of nanomaterials in combating mango malformation. Hence, the present review aims to provide brief information on the disease and effective management strategies.

Real-world data of siltuximab for Chinese patients with iMCD: combination with BCD regimen as a potential approach for severe cases

Idiopathic multicentric Castleman disease (iMCD) is a rare disease characterized by polyclonal lymphoproliferation and systemic inflammation. Siltuximab, targeting interleukin-6 (IL-6), has been recommended as the first-line therapy for iMCD. However, substantial real-world data from China were still lacking, and treatment for patients with severe iMCD remained challenging. This single-center retrospective study investigated the real-world efficacy and safety of siltuximab-based therapy in 43 consecutive patients with iMCD in China from July 2022 to March 2024. The overall response rate (including symptomatic and biochemical response) was 59% at week 3 and increased to 91% at week 12, with complete and partial response rates of 54% and 37%, respectively. Patients who received siltuximab as a first-line treatment exhibited better treatment response (OR = 0·040, 95% CI, 0·004 - 0·390, p = 0·006). Inflammatory markers (such as interleukin-6 and high-sensitivity C-reactive protein [hsCRP]) and pathologic types showed no predictive role in the treatment responses. Eighteen patients, who were all classified as severe iMCD, received combined therapy of siltuximab and BCD regimen (bortezomib, cyclophosphamide and dexamethasone). Of them, the overall response rate was 50% at week 3, which increased to 100% at week 12. Our findings reinforced the existing evidence on the efficacy and safety of siltuximab and highlighted the potential benefits of combining siltuximab with BCD regimen in severe iMCD patients.

Mouse models of Kaposi sarcoma-associated herpesvirus (KSHV)

Infection with Kaposi sarcoma-associated herpesvirus (KSHV) is a prerequisite for the development of several human cancers, including Kaposi sarcoma and primary effusion lymphoma. Efficient long-term infection with KSHV and subsequent virally induced cell transformation is limited to humans, resulting in a lack of small animal models for KSHV-driven malignancies. Various attempts to create a mouse model for KSHV include infection of humanized mice, generating transgenic mice that ectopically express viral proteins, and grafting KSHV-infected tumor, primary, or immortalized cells onto immunodeficient mice. While no single mouse model can recapitulate the full range of KSHV-associated pathologies described in humans, each model adds an essential piece to the complete picture of KSHV infection and oncogenesis.

No evidence for active viral infection in unicentric and idiopathic multicentric Castleman disease by Viral-Track analysis

Castleman disease (CD) is a rare hematologic disorder characterized by pathologic lymph node changes and a range of symptoms due to excessive cytokine production. While uncontrolled infection with human herpesvirus-8 (HHV-8) is responsible for the cytokine storm in a portion of multicentric CD (HHV-8-associated MCD) cases, the etiology of unicentric CD (UCD) and HHV-8-negative/idiopathic MCD (iMCD) is unknown. Several hypotheses have been proposed regarding the pathogenesis of UCD and iMCD, including occult infection given the precedent established by HHV-8 infection. To investigate potential active infections in UCD and iMCD, we implemented Viral-Track, a computational method that identifies viral mRNA sequences from next-generation sequencing data. We applied Viral-Track to short sequencing reads from a cohort of UCD (n = 22), iMCD (n = 19), and controls (n = 86). While viral sequences for several unusual viruses were identified in individual CD patients,  sequences for the same virus were not found across multiple CD patients or they were not specific to CD samples and were also found in non-CD samples. These results suggest that active viral infection is unlikely to be a pathological driver of UCD or iMCD.

Identifying Castleman disease from non-clonal inflammatory causes of generalized lymphadenopathy

Idiopathic multicentric Castleman disease (iMCD) is a rare, life-threatening subtype of Castleman disease (CD), which describes a group of rare, polyclonal lymphoproliferative disorders that demonstrate characteristic histopathology and variable symptomatology. iMCD involves a cytokine storm that occurs due to an unknown cause. Rapid diagnosis is required to initiate appropriate, potentially life-saving therapy, but diagnosis is challenging and impeded by clinical overlap with a wide spectrum of inflammatory, neoplastic, and infectious causes of generalized lymphadenopathy. Diagnosis, which requires both consistent histopathologic and clinical criteria, can be further delayed in the absence of close collaboration between clinicians and pathologists. A multimodal assessment is necessary to effectively discriminate iMCD from overlapping diseases. In this review, we discuss a pragmatic approach to generalized lymphadenopathy and clinical, laboratory, and histopathological features that can aid with identifying iMCD. We discuss diagnostic barriers that impede appropriate recognition of disease features, diagnostic criteria, and evidence-based treatment recommendations that should be initiated immediately following diagnosis.

Anemia of inflammation and iron metabolism in chronic diseases

Anemia of Inflammation begins with the activation of the immune system and the subsequent release of cytokines that lead to an elevation of hepcidin, responsible for hypoferremia, and a suppression of erythropoiesis due to lack of iron. The anemia is usually mild/moderate, normocytic/normochromic and is the most prevalent, after iron deficiency anemia, and is the most common in patients with chronic diseases, in the elderly and in hospitalized patients. Anemia can influence the patient's quality of life and have a negative impact on survival. Treatment should be aimed at improving the underlying disease and correcting the anemia. Intravenous iron, erythropoietin and prolyl hydroxylase inhibitors are the current basis of treatment, but future therapy is directed against hepcidin, which is ultimately responsible for anemia.

A case of TAFRO syndrome after vaccination, successfully treated with cyclosporine

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.

TAFRO Syndrome: Guidance for Managing Patients Presenting Thrombocytopenia, Anasarca, Fever, Reticulin Fibrosis, Renal Insufficiency, and Organomegaly

TAFRO syndrome is an inflammatory disorder of unknown etiology characterized by thrombocytopenia, anasarca, fever, reticulin fibrosis, renal insufficiency, and organomegaly. Despite great advancements in research on the TAFRO syndrome in the last decade, its diagnosis and treatment are still challenging for most clinicians because of its rarity and severity. Since the initial proposal of the TAFRO syndrome as a distinct disease entity in 2010, two independent diagnostic criteria have been developed. Although these are different in the concept of whether TAFRO syndrome is a subtype of idiopathic multicentric Castleman disease or not, they are similar except for the magnitude of lymph node histopathology. Because there have been no specific biomarkers, numerous diseases must be ruled out before the diagnosis of TAFRO syndrome is made. The standard of care has not been fully established, but interleukin-6 blockade therapy with siltuximab or tocilizumab and anti-inflammatory therapy with high-dose corticosteroids are the most commonly applied for the treatment of TAFRO syndrome. The other immune suppressive agents or combination cytotoxic chemotherapies are considered for patients who do not respond to the initial treatment. Whereas glowing awareness of this disease improves the clinical outcomes of patients with TAFRO syndrome, further worldwide collaborations are warranted.