Successful treatment of aggressive HIV-associated multicentric Castleman's disease: a case report
Multicentric Castleman's disease (MCD) in human immunodeficiency virus (HIV)-infected patients is an aggressive form of lymphoproliferative disorder that usually has a rapidly fatal outcome. Overall mortality is 70%-85%, and median survival is only 8-14 months. No standard or optimal therapy for MCD has been established. A 49-year-old man with HIV infection presented with 1-week duration of low-grade fever, night sweats, left sided abdominal pain, and generalized weakness. Physical examination revealed a supraclavicular, anterior cervical and axillary lymphadenopathy, and splenomegaly. Excisional biopsy of the left axillary lymph node confirmed the diagnosis of an angiofollicular hyperplasia, or MCD, hyaline vascular type with CD20 positivity. Treatment included a combination of the chemotherapy regimen of cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) with the monoclonal anti-CD20 antibody rituximab. The chemotherapy was administered in parallel with highly active antiretroviral therapy (HAART). At a 3-year follow-up, the patient remains in complete remission and his HIV parameters have normalized with continued HAART. This is the second publication describing the use of an aggressive combination of chemotherapy with rituximab in HIV-associated MCD. For an HIV patient with MCD, an aggressive treatment with full CHOP regimen combined with monoclonal anti-CD20 antibody rituximab should be considered, and the use of HAART does not need to be discontinued.