title: Successful tocilizumab treatment in a patient with human herpesvirus 8-positive and human immunodeficiency virus-negative multicentric Castleman's disease of plasma cell type nonresponsive to rituximab-CVP therapy.
abstract: We present and discuss the case of a HIV-negative female finally diagnosed upon histopathologic and molecular biologic evaluations with human herpesvirus 8 (HHV8)-positive multicentric Castleman's disease (MCD) of plasma cell type, but with no detectable HHV8-DNA in peripheral blood. She failed to respond to combination immunosuppressive therapeutic trials of corticosteroids and azathioprine, and neither an immunochemotherapy of rituximab-CVP (R-CVP) induced disease resolution. However, monoclonal anti-IL-6R antibody (tocilizumab) immunotherapy resulted in beneficial disease stabilization. A control lymph node biopsy indicated mild polyclonal plasmacytosis, and a negative HHV8 determination. The patient is still receiving tocilizumab. This case emphasizes the individual nature of MCD requiering more personalized disease management.
authors.affiliation: 2nd Department of Medicine, Semmelweis University, Budapest, Hungary. muzes.gyorgyi@med.semmelweis-univ.hu
authors.forename: Györgyi
authors.initials: G
authors.lastname: Műzes
authors.forename: Ferenc
authors.initials: F
authors.lastname: Sipos
authors.forename: Judit
authors.initials: J
authors.lastname: Csomor
authors.forename: Lídia
authors.initials: L
authors.lastname: Sréter
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D001379:Azathioprine / Q000627:therapeutic use; D005871:Castleman Disease / Q000188:drug therapy* / Q000503:physiopathology; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D018023:HIV Seronegativity; D019288:Herpesvirus 8, Human / Q000302:isolation & purification*; D006801:Humans; D008198:Lymph Nodes / Q000503:physiopathology; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D058846:Antibodies, Monoclonal, Murine-Derived; D004279:DNA, Viral; D000069283:Rituximab; C502936:tocilizumab; D001379:Azathioprine