Thoracic Radiographic and CT Findings of Multicentric Castleman Disease in HIV-infected Patients

Abstract

Multicentric HIV-related Castleman disease (MCD) is a rare and severe disorder of lymphoid tissue inducing high-grade fever, hepatosplenomegaly, and diffuse peripheral lymphadenopathy. During clinical exacerbations, bilateral interstitial pneumonia may occur. In this pictorial essay, we describe different thoracic imaging of MCD, with particular emphasis on computed tomography findings, in 13 HIV-infected patients with histologically proved MCD.

Pulmonary manifestations of human herpesvirus-8 during HIV infection

“…A small pleural effusion may be present. CT scan results appear normal with resolution of the flare [71].…”

“…Sheets of plasma cells are present in interfollicular areas. Results of only one surgical lung biopsy have been reported and showed lesions similar to those in lymph nodes [71].…”

iNKT cell defects in HHV-8–associated MCD

“…In contrast, HHV-8-associated MCD generally occurs in the setting of relatively preserved CD4 1 T-cell counts, HHV-8-specific effector CD8 1 T cells are demonstrable, 7 and incidence may actually be increasing because people coinfected with HIV and HHV-8 are living longer on antiretroviral therapy. 8 The work by Sbihi et al provides important insights into the immunobiology of HHV-8-associated MCD and contributes to our understanding of these clinical observations.…”

“…Factors that could affect the relative fitness of competitive repopulation by posttreatment Ph-negative vs residual CML stems cells, changes in the stem cell niche microenvironment of CML patients, or differences in the immunological profiles of relapsing vs nonrelapsing patients have raised new hypothesis regarding the still mysterious process whereby a durable TFR can be achieved in some patients. 7,8 The goalpost has clearly shifted to findings ways to achieve a TFR in the majority of patients, and the road ahead looks exciting and promising. iNKT cell defects in the setting of immune disorders, HHV-8 can lead to 2 important proliferative disorders, KS and a plasmablastic form of MCD, HHV-8-associated MCD.…”

Thoracic Diseases Associated with HIV Infection in the Era of Antiretroviral Therapy: Clinical and Imaging Findings

“…HIV-infected patients with MCD experience relapsing constitutional symptoms of fever, malaise, and weight loss that can fluctuate over days (43,44). Respiratory symptoms, pleural effusion, ascites, peripheral edema, hepatosplenomegaly, and diffuse lymphadenopathy can occur (40,41,43).…”