Multicentric Angiofollicular Lymph Node Hyperplasia (Castleman’s Disease) Followed by Kaposi’s Sarcoma in Two Homosexual Males with the Acquired Immunodeficiency Syndrome (AIDS)

Abstract

Two homosexual men with the acquired immunodeficiency syndrome (AIDS) who developed a multicentric variant of angiofollicular lymph node hyperplasia (AFLNH) (Castleman's disease) and Kaposi's sarcoma are reported. Both had diffuse adenopathy, splenomegaly, and a systemic inflammatory state. Both had an absolute increase in Leu 1+ lymphocytes, which was associated with markedly decreased Leu 3+ lymphocytes, markedly increased Leu-2+ lymphocytes, and a very low Leu 3/2 ratio. The lymphocytes of both patients had a normal blastogenic response to PHA. The lymphocytes of patient 1 had a poor response to autologous or allogenic cells in the mixed lymphocyte culture reaction. AFLNH represents another lymphoreticular complication of AIDS. Given the interrelationships between AFLNH, the development of Kaposi's sarcoma, and the aggressive clinical course seen in our two patients and those in the literature, the aggressive use of lymph node biopsy may be an important prognostic tool for the patient with the acquired immunodeficiency syndrome.

The management of unicentric and multicentric Castleman's disease

“…6 The cause of CD is unknown, although several theories have been formulated to account for the spectrum of associated pathologic and clinical features. Chronic low grade inflammation, 1 hamartomatous process, 27,28 an immunodeficiency state, 21,29,30 and autoimmunity 10 have all been proposed as likely pathogenetic mechanisms. Epstein-Barr virus, Toxoplasma, and Mycobacterium tuberculosis have also been implicated in some cases of CD of the PC type.…”

How I treat HIV-associated multicentric Castleman disease

“…10,12,39,43,[45][46][47][48][49][50][51][52][53][54][55] Although rapid resolution of symptoms has been reported in patients with active disease, relapses occur frequently and the progression-free survival is often brief. A strategy using maintenance oral etoposide (100-200 mg/m 2 , weekly) has been adopted in France.…”

Fracaso renal agudo por microangiopatía trombótica asociado a enfermedad de Castleman

“…El tipo hialino-vascular constituye el 80-90% de los casos y la variante de células plasmáticas el 10%, encontrán-dose en ocasiones datos histológicos de las dos variantes en un mismo nódulo linfático lo que se conoce cómo variante mixta de la enfermedad de Castleman. La enfermedad de Castleman se ha asociado a pacientes VIH con sarcoma de Kaposi infectados por el virus herpes 8, detectándose el virus del herpes 8 en el 40% de los pacientes con la forma multicéntrica (8). También se ha descrito un aumento en la incidencia del linfoma de Hodgkin en pacientes con enfermedad de Castleman (9).…”