Pulmonary manifestations of multicentric Castleman's disease in HIV infection: a clinical, biological and radiological study

Abstract

The aim of the present study was to report clinical, radiological and bronchoalveolar lavage (BAL) findings in patients with pulmonary manifestations of HIV-associated multicentric Castleman's disease (MCD).This was a retrospective study of 12 patients with histologically proven MCD. Clinical manifestations were as follows: dyspnoea (nine out of 12 cases), cough (n510), bilateral crackles (n510), together with high fever, malaise, peripheral lymphadenopathy (n512), and hepatosplenomegaly (n510). Two patients developed acute respiratory distress syndrome. Chest radiographs and computed tomography scans showed reticular (n57) and/or nodular (n57) interstitial patterns, with mediastinal lymphadenopathy (n59), and bilateral pleural effusion (n53). Fibreoptic endoscopy was normal in all cases. BAL analysis showed hypercellularity (n56) and/or lymphocytosis (n56), and human herpesvirus-8 DNA was detected in two out of two cases. Specific stains and cultures for pathogens were negative. All patients received etoposide and/or vinblastine, and improved after 2-4 days. Relapses were frequent (50 attacks in 12 patients). Six patients developed a non-Hodgkin's lymphoma, and five died.In conclusion, the pulmonary manifestation of HIV-related multicentric Castleman's disease is an acute reticulo-nodular interstitial pneumonitis, associated with severe systemic symptoms and peripheral lymphadenopathy. In bronchoalveolar lavage fluid, cellularity is not specific and human herpesvirus-8 DNA is detected. The clinical course is specific due to a rapid onset and regression, frequent relapses and a high occurrence of non-Hodgkin's lymphoma.

POEMS Syndrome Manifested as Systemic Capillary Leak Syndrome: A Case Report

“…In MCD, increased serum vascular endothelial growth factor (VEGF) and interleukin 6 levels were associated with capillary damage and leak of plasma to interstitium, decreasing circulatory volume [9]. In 12 patients with MCD and HIV, two had adult respiratory distress syndrome [10].…”

Castleman disease and lymphocytic interstitial pneumonia: a complex diagnostic and management challenge

“…Interleukin-6 (IL-6) is implicated in CD pathogenesis, inducing B-cell proliferation, hypergammaglobulinanemia, and acute phase responses 1 . Mediastinal lymphadenopathy is common but other pulmonary manifestations are infrequent 2,3 . Multiple treatments have been reported 1 ; unsurprisingly an evolving role of biological therapies is emerging.…”

Pulmonary manifestations of human herpesvirus-8 during HIV infection

“…BALF analysis revealed increased cellular counts in five out of 11 patients and increased alveolar lymphocytes in seven out of 11. None had a simultaneous pulmonary opportunistic infection [70].…”

“…Haemoptysis is rare. Pulmonary auscultation may show crackles [67,69,70]. When respiratory symptoms are present, chest radiography shows bilateral interstitial opacities that may consolidate to alveolar opacities.…”

“…PCR and serology are then helpful [80]. During HIV infection, pulmonary manifestations of MCD should exclude infections that justify bronchoscopy with BALF analysis [70]. Haemophagocytosis may provoke anasarca with pleural effusion.…”