Hassan A, Carroll C, Espina T (2015) Rapidly Progressive Multicentric Castleman’s Disease in Patient with Acute Retroviral Syndrome: A Case Report. Int J AIDS Res. 02(4), 34-36 34 http://scidoc.org/IJHR.php Rapidly Progressive Multicentric Castleman’s Disease in Patient with Acute Retroviral Syndrome: A Case Report Case Report Hassan A * , Carroll C, Espina T Advocate Illinois Masonic Medical center, Chicago, USA. *Corresponding Author: Abdalla Hassan, MD, Internal Medicine Resident, Internal Medicine Department, 7th loor Advocate Illinois Masonic Medical Center, 836 W Wellington Ave, Chicago, IL 60657, USA. Tel: +1-347-873-2073 E-mail: abdalla.hassan@advocatehealth.com Recieved: April 06, 2015 Accepted: April 29, 2015 Published: May 05, 2015 Citation: Hassan A, Carroll C, Espina T (2015) Rapidly Progressive Multicentric Castleman’s Disease in Patient with Acute Retroviral Syn- drome: A Case Report. Int J AIDS Res. 02(4), 34-36. doi: http://dx.doi. org/10.19070/2379-1586-150007 Copyright: Hassan A © 2015. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited. Introduction Multicenteric Castleman’s Disease (MCD) or angiofollicular dys- plasia is a lymphoproliferative disorder that happens with in- creased frequency in Human Herpes Virus-8 (HHV-8) positive HIV patients. HHV-8 also causes Kaposi sarcoma and primary effusion lymphoma, and it is responsible for around 50% of MCD cases. We present a very unique case of rapidly progressive Multicenteric Castleman’s Disease in newly diagnosed HIV posi- tive male with acute retroviral syndrome before the initiation of Anti- Retroviral Therapy (ART). Case Presentation A 40 year old homosexual male presented to our institution with fevers, chills and a syncopal episode. He has a past medical history of hypertension and illicit drug use. He was originally seen at an outside clinic for anal pain and was diagnosed with HIV ive days prior to his admission. Two weeks prior to his admission he had also experienced an episode of syncope, followed by 5 days of fever and chills and diffuse body aches. He also reported having a negative HIV test 2 months earlier. On presentation to emergency department he was not in acute distress, febrile with a tempera- ture of 101ºF (38.3 ºC), tachycardic (max HR= 110) and normo- tensive. Physical examination demonstrated right sided non ten- der cervical lymphadenopathy with hepatosplenomegaly. His labs were signiicant for pancytopenia (WBC of 4.1 thousand/mcL; HgB 6.1gm/dL; MCV82fL; Platelet 78 thousand/mcL), hypona- tremia (131mmol/L), and elevated creatinine (1.5mg/dL). Chest X-Ray was not impressive. At that time the working diagnosis was acute retroviral syndrome given his symptoms and lab indings, although the anemia was too severe to be due to HIV only. Immediately he was transfused 2 units of Packed Red Blood Cells. His repeat Hemoglobin showed minimal improvement despite transfusion and this was very unu- sual in case of acute retroviral syndrome. Haptogoblin and bili- rubin were normal. Peripheral blood smear showed spherocytosis and iron studies were signiicant for anemia of chronic disease. Later that day Computed Tomography of Abdomen and Pelvis was done and it was signiicant for hepatosplenomegaly with mul- tiple enlarged retroperitoneal lymph nodes in the abdomen and Abstract Multicentric Castleman’s Disease (MCD) is a lymphoproliferative disorder that happens more in Human Herpes Virus-8 (HHV-8) positive HIV patients. We are reporting a unique case of rapidly progressive Multicenteric Castleman’s disease in patient with acute retroviral syndrome. We are presenting a 40 year old male presented with fevers, chills and syncope. He was recently diagnosed with HIV. On presentation he was febrile. Physical examination demonstrated cervical lymphad- enopathy with hepatosplenomegaly. His labs were signiicant for pancytopenia and hyponatremia. A working diagnosis of acute retroviral syndrome was made, although the anemia was too severe to be due to HIV only. He received blood transfu- sion, but the hemoglobin showed minimal improvement. CTAbdomen/pelvis was done and showed hepatosplenomegaly with enlarged lymph nodes. Lymph node biopsy was consistent with HHV-8 associated MCD. Accordingly, he was started on Anti-Retroviral Therapy for HIV and Gancyclovir and Rituxamab for MCD. Two days later, he continued to deteriorate and his blood counts dropped requiring multiple units of transfusion. Consequently, he developed severe respiratory dis- tress, ventilated, and then he expired. In conclusion, we believe that occurrence of Castleman’s disease in acute HIVpatients before ART initiation is a poor prognostic sign and physicians should be aware of such entity. Keywords: Multicentric Castleman’s Disease; Acute Retroviral Syndrome; Anti-Retroviral Therapy. International Journal of HIV/AIDS and Research (IJHR) ISSN: 2379-1586