title: Castleman's disease--a two compartment model of HHV8 infection.
abstract: Castleman's disease is a primary infectious disease of the lymph node that causes local symptoms or a systemic inflammatory syndrome. Histopathology reveals a destroyed lymph node architecture that can range from hyaline-vascular disease to plasma-cell disease. Viral interleukin 6 (vIL-6) produced during the replication of human herpesvirus type 8 (HHV8) is the key driver of systemic inflammation and cellular proliferation. Stage progression of Castleman's disease results from switches between viral latency and lytic replication, and lymphatic and hematogenous spread. Multicentric plasma-cell disease in HIV-1 patients is associated with HHV8 infection. Polyclonal plasmablast proliferation escapes control in the germinal center with eventual malignant transformation into non-Hodgkin lymphoma. Surgery produces excellent results in unicentric disease, while multicentric disease responds to anti-CD20 therapy or IL-6 and chemotherapy. Lymphovascular endothelium and naive B cells are infectious reservoir-opening options for antiangiogenic and anti-CD19 strategies to enhance outcomes in patients with systemic disease.
authors.affiliation: Department of Endocrine Surgery, King's College Hospital, Denmark Hill, London SE5 9RS, UK. klaus‑martin.schulte@nhs.net
authors.forename: Klaus-Martin
authors.initials: KM
authors.lastname: Schulte
authors.forename: Nadia
authors.initials: N
authors.lastname: Talat
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D001402:B-Lymphocytes / Q000276:immunology; D005871:Castleman Disease / Q000276:immunology / Q000473:pathology* / Q000628:therapy / Q000821:virology; D018450:Disease Progression; D015658:HIV Infections / Q000150:complications*; D006566:Herpesviridae Infections / Q000150:complications / Q000276:immunology*; D019288:Herpesvirus 8, Human / Q000276:immunology / Q000502:physiology*; D006801:Humans; D015850:Interleukin-6 / Q000096:biosynthesis* / Q000276:immunology; D008198:Lymph Nodes / Q000473:pathology; D014779:Virus Replication / Q000276:immunology
chemical_list: D000998:Antiviral Agents; D015850:Interleukin-6