Liver cirrhosis in a child associated with Castleman's disease: A case report.

BACKGROUND

Castleman's disease (CD) is a lymphoproliferative disorder. TAFRO syndrome is classified as a variant of CD based on its key clinical manifestations of thrombocytopenia, anasarca (generalized edema and pleural effusion), fever (pyrexia), reticulin fibrosis in the bone marrow and the proliferation of megakaryocytes, and organomegaly (such as hepatosplenomegaly and multiple lymphadenopathies); TAFRO syndrome is mainly reported in Japanese patients. To our knowledge, this is the first pediatric case report detailing a CD-associated disorder progressing to cirrhosis.

CASE SUMMARY

A 10-year old male patient presented with fever and anemia. Six months before hospitalization, he had remarkable abdominal distention. Subsequently, he visited a clinic for a fever that lasted 5 d. The physical findings were marked hepatosplenomegaly and cervical lymphadenopathy. A blood test revealed leukocytosis, microcytic anemia, aspartate aminotransferase-dominant transaminase elevation, high levels of C-reactive protein, polyclonal hypergammaglobulinemia, and high levels of interleukin-6 and vascular endothelial growth factor. Abdominal contrast computed tomography and magnetic resonance imaging suggested cirrhosis, which was confirmed by liver histology. Histological findings in the enlarged hepatic lymph nodes revealed both hyperplasia and atrophy of lymphoid follicles with some vascular hyperplasia and moderate plasmacytosis between the lymphoid follicles, which is compatible with lymph node histology in TAFRO syndrome. Prednisolone was not effective in reducing the patient's symptoms; therefore, the patient was prescribed tocilizumab. To date, the patient remains free of fever and continues to receive tocilizumab.

CONCLUSION

We described the clinicopathological features of TAFRO syndrome to highlight the clinical presentation of this rare disease in a pediatric case.

Informations de copyright

©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.

Déclaration de conflit d'intérêts

Conflict-of-interest statement: The fifth author accepts remuneration from "EA Pharma Co., Ltd., Otsuka Pharmaceutical Factory, Inc." The sixth author accepts remuneration from "Chugai Pharmaceutical Co., Ltd., UCB Japan Co., Ltd., CSL Behring, Abbvie Japan Co., Ltd., Japan Blood Products Organization, Ayumi Pharmaceutical Co., Nippon Kayaku Co., Ltd., MSD K.K., Daiichi Sankyo Co., Ltd., Taisho Pharmaceutical Co., Ltd., and Asahikasei Pharmaceutical Co." Other authors declare that there is no conflict of interest. Even though there is a COI to disclose as of January 2020, this will not prevent the submission from proceeding.