Severe systemic inflammation mimicking TAFRO syndrome following COVID-19

Tane, Misato; Kosako, Hideki; Hosoi, Hiroki; Tabata, Keisuke; Hiroi, Takayuki; Osawa, Kosuke; Iwamoto, Ryuta; Murata, Shogo; Mushino, Toshiki; Murata, Shin‐ichi; Araki, Shin‐ichi; Fujii, Takao; Sawada, Takashi

doi:10.1007/s12185-023-03589-9

Cited by 5 publications

(4 citation statements)

References 39 publications

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“…In severe cases of COVID-19, the level of IFN-I has been increased over time 43 . A Case that presented with TAFRO-like symptoms after the onset of COVID-19 was positive for anti-SS-A antibody 44 . Based on the above, it is possible that the IFN-I response triggered by such as viral infection may be involved in the development of both anti-SS-A antibodies and TAFRO-like manifestations.…”

Section: Discussionmentioning

confidence: 99%

TAFRO syndrome is associated with anti-SSA/Ro60 antibodies, in contrast to idiopathic castleman disease

Shirakashi,

Nishida,

Nakashima

et al. 2024

Sci Rep

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TAFRO syndrome is an acute systemic inflammatory disease characterized by thrombocytopenia, anasarca, fever, reticulin fibrosis/renal dysfunction, and organomegaly. There have been increasing reports that TAFRO is a disease distinct from idiopathic multicentric Castleman disease and that TAFRO patients may be positive for anti-SSA antibodies. To assess anti-SSA antibody positivity and the clinical characteristics of the two diseases, we retrospectively compared 7 TAFRO and 10 iMCD patients in our hospital. The mean age of onset of TAFRO and iMCD was 48.0 (interquartile range [IQR], 41–53) and 45.0 (IQR, 35–53) years, respectively. The TAFRO and iMCD groups had 6 (86%) and 4 (40%) male patients, respectively, and the following pretreatment laboratory values: platelet count, 3.8 (IQR, 2.2–6.4) and 35.5 (IQR, 22.2–42.8) × 104/μL, respectively; C-reactive protein, 10.2 (IQR, 6.8–21.4) and 9.5 (IQR, 6.2–13.6) mg/dL, respectively; IgG, 1431 (IQR, 1112–1815) and 4725 (IQR, 3755–5121) mg/dL, respectively. RNA immunoprecipitation (5 cases for anti-SSA) or protein array (5 cases for anti-SSA/Ro60) detected anti-SSA antibodies in six (86%) TAFRO patients but not in iMCD patients; it did not detect anti-SSB antibodies in any of the patients. None of the patients were diagnosed with Sjögren syndrome. All iMCD patients treated with tocilizumab (TCZ) responded well. Meanwhile, two of six TAFRO patients treated with TCZ showed inadequate responses; thus, both patients were switched to rituximab, following which they achieved remission. TAFRO and iMCD have different clinical features. TAFRO may be categorized as a severe phenotype of the anti-SSA antibody syndrome.

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Section: Discussionmentioning

confidence: 99%

TAFRO syndrome is associated with anti-SSA/Ro60 antibodies, in contrast to idiopathic castleman disease

Shirakashi,

Nishida,

Nakashima

et al. 2024

Sci Rep

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“…Cases of kidney injury, such as IgA nephropathy [7], minimal change disease [8][9][10], and IgG4-related disease [11], following mRNA vaccination has accumulated in current research. Recently, few cases of TAFRO syndrome [12,13] and iMCD [14] developed after COVID-19 vaccination or COVID-19 infection was reported. Yamada et al reported TAFRO syndrome with a serious clinical course triggered by the second COVID-19 mRNA vaccination [12].…”

Section: Discussionmentioning

confidence: 99%

A Case of TAFRO Syndrome Developed after COVID-19 Vaccination

Hirose,

Suzuki,

Umezawa

et al. 2023

Case Reports in Nephrology

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TAFRO syndrome is a systemic inflammatory disorder, which is characterized by thrombocytopenia, anasarca, fever, reticulin myelofibrosis, renal dysfunction, and organomegaly. It often presents with progressive clinical symptoms and can be fatal. COVID-19 vaccination is important to reduce the number of COVID-19-infected populations and lower the risk of becoming severe. However, serious adverse events have been reported. TAFRO syndrome that progresses after the COVID-19 mRNA vaccination has not yet been reported. A 45-year-old man developed fever, gross hematuria, renal dysfunction, pleural effusions, and ascites immediately after vaccination. This case fulfilled three major categories (thrombocytopenia, anasarca, and systemic inflammation) and two minor categories (renal insufficiency and myelofibrosis) and was diagnosed with TAFRO syndrome. High-dose steroid treatment was initiated, followed by prednisolone administration. After treatment, renal dysfunction and fluid retention were resolved. Universal vaccination against COVID-19 is important for lowering the risk of spreading COVID-19 infection. Several complications, such as renal, hematological, and heart diseases, have been reported; however, its pathogenesis is unclear. The possibility of various complications after the COVID-19 vaccination, including TAFRO syndrome, should be considered.

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“…In these two cases, in situ hybridization of lymph node biopsy samples showed cells that were positive for EBV-encoded RNA. Recently, we reported a case of severe systemic inflammation mimicking TAFRO that arose after COVID-19, as described in detail in Section 5 [ 22 ].…”

Section: Etiologies Of Tafro Syndrome and MCD Focusing On Viral Infec...mentioning

confidence: 99%

“…TAFRO syndrome and excessive immunoreaction after severe COVID-19 can induce similar symptoms and pathophysiologies through cytokine storms. A 61-year-old Japanese female was initially reported to have severe systemic inflammation mimicking TAFRO syndrome following COVID-19 [ 22 ]. She developed a fever, anasarca, renal failure, organomegaly, and thrombocytopenia three weeks after COVID-19.…”

Section: Tafro Syndrome and Covid-19mentioning

confidence: 99%

TAFRO Syndrome and COVID-19

Tane,

Kosako,

Sonoki

et al. 2024

Biomedicines

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TAFRO syndrome is a systemic inflammatory disease characterized by thrombocytopenia and anasarca. It results from hyperinflammation and produces severe cytokine storms. Severe acute respiratory syndrome coronavirus 2, which led to the coronavirus disease 2019 (COVID-19) pandemic, also causes cytokine storms. COVID-19 was reported to be associated with various immune-related manifestations, including multisystem inflammatory syndrome, hemophagocytic syndrome, vasculitis, and immune thrombocytopenia. Although the pathogenesis and complications of COVID-19 have not been fully elucidated, the pathogeneses of excessive immunoreaction after COVID-19 and TAFRO syndrome both involve cytokine storms. Since the COVID-19 pandemic, there have been a few case reports about the onset of TAFRO syndrome after COVID-19 or COVID-19 vaccination. Castleman disease also presents with excessive cytokine production. We reviewed the literature about the association between TAFRO syndrome or Castleman disease and COVID-19 or vaccination against it. While the similarities and differences between the pathogeneses of TAFRO syndrome and COVID-19 have not been investigated previously, the cytokines and genetic factors associated with TAFRO syndrome and COVID-19 were reviewed by examining case reports. Investigation of TAFRO-like manifestations after COVID-19 or vaccination against COVID-19 may contribute to understanding the pathogenesis of TAFRO syndrome.

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Severe systemic inflammation mimicking TAFRO syndrome following COVID-19

Cited by 5 publications

References 39 publications

TAFRO syndrome is associated with anti-SSA/Ro60 antibodies, in contrast to idiopathic castleman disease

TAFRO syndrome is associated with anti-SSA/Ro60 antibodies, in contrast to idiopathic castleman disease

A Case of TAFRO Syndrome Developed after COVID-19 Vaccination

TAFRO Syndrome and COVID-19

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