Cancer Res Treat.  2009 Jun;41(2):104-107.

Complete Remission in a Patient with Human Herpes Virus-8 Negative Multicentric Castleman Disease Using CHOP Chemotherapy

• Seo HY
• Kim EB
• Kim JW
• Shin BK
• Kim SJ
• Kim BS

Abstract

Multicentric Castleman disease (MCD) is a rare lymphoproliferative disorder. Although MCD pathogenesis is unclear, studies have suggested that human herpesvirus 8 (HHV-8) may be associated with the disorder. Recent reports have identified MCD cases without viral infection. A 43-year-old woman presented to our hospital for fever and myalgia of 6 months' duration. The complete blood count revealed an elevated leukocyte count (15.1x10(3)/microliter) and a decreased hemoglobin level of 10.0 g/dL. The C-reactive protein level was elevated at 276.5 mg/L. Thoracic computed tomography (CT) scans revealed bilateral axillary lymphadenopathy. There was no evidence of HHV-8, human immunodeficiency virus (HIV), or Mycobacterium infection. Histologic evaluation of a lymph node biopsy from the left axilla yielded a diagnosis of MCD. Cyclophosphamide, adriamycin, vincristine, and prednisone (CHOP) were administered for a total of 4 cycles. The patient's fever and lymphadenopathy resolved after the course of chemotherapy. She has been in complete remission for 24 months at this writing. As previously reported, this case report suggests that MCD can develop without viral infection. CHOP chemotherapy may be an effective treatment option for newly diagnosed MCD patients.

Keyword

Chemotherapy; Human herpes virus 8; Multicentric Castleman disease

MeSH Terms

Adult
Axilla
Biopsy
Blood Cell Count
C-Reactive Protein
Corneal Dystrophies, Hereditary
Cyclophosphamide
Doxorubicin
Female
Fever
Giant Lymph Node Hyperplasia
Hemoglobins
Herpesvirus 8, Human
HIV
Humans
Leukocyte Count
Lymph Nodes
Lymphatic Diseases
Lymphoproliferative Disorders
Mycobacterium Infections
Prednisone
Vincristine
Writing
C-Reactive Protein
Corneal Dystrophies, Hereditary
Cyclophosphamide
Doxorubicin
Hemoglobins
Prednisone
Vincristine

Figure

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  Fig. 1 Chest CT scan on admission revealed bilateral axillary lymphadenopathy.

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  Fig. 2 Left axillary lymph node biopsy. (A) Heavy infiltration of plasma cells and occasional eosinophils in the medullary cords and interfollicular areas (H & E, ×400). (B) Plasma cells were strongly reactive for Vs38, and some cells were large and multinucleated (Vs38 Immunohistochemical stain, ×400).

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  Fig. 3 Left axillary lymph node biopsy. (A) Lambda immunohistochemical stain, ×400. (B) Kappa immunohistochemical stain, ×400. Plasma cells were polyclonal and both lambda and kappa positive.

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  Fig. 4 HHV-8 nested polymerase chain reaction. Lane M=100 bp ladder, Lane 1=blood, Lane 2=tissue, Lane 3=distilled water (negative control), Lane 4=BCBL-1 (positive control). HHV-8, human herpesvirus 8.

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  Fig. 5 Chest CT scan after treatment with resolution of bilateral axillary lymphadenopathy.

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