title: The first report of adolescent TAFRO syndrome, a unique clinicopathologic variant of multicentric Castleman's disease.
abstract: BACKGROUND
  TAFRO syndrome is a unique clinicopathologic variant of multicentric Castleman's disease that has recently been identified in Japan. It is characterized by a constellation of symptoms: Thrombocytopenia, Anasarca, reticulin Fibrosis of the bone marrow, Renal dysfunction and Organomegaly (TAFRO). Previous reports have shown that affected patients usually respond to immunosuppressive therapy, but the disease sometimes has a fatal course. TAFRO syndrome occurs in the middle-aged and elderly and there are no prior reports of the disease in adolescents. Here we report the first adolescent case, successfully treated with anti-IL-6 receptor antibody (tocilizumab, TCZ) and monitored with serial cytokine profiles.
  
  
  METHODS
  A 15-year-old Japanese boy was referred to us with fever of unknown origin. Whole body computed tomography demonstrated systemic lymphadenopathy, organomegaly and anasarca. Laboratory tests showed elevated C-reactive protein and hypoproteinemia. Bone marrow biopsy revealed a hyperplastic marrow with megakaryocytic hyperplasia and mild reticulin fibrosis. Despite methylprednisolone pulse therapy, the disease progressed markedly to respiratory distress, acute renal failure, anemia and thrombocytopenia. Serum and plasma levels of cytokines, including IL-6, vascular endothelial growth factor, neopterin and soluble tumor necrosis factor receptors I and II, were markedly elevated. Repeated weekly TCZ administration dramatically improved the patient's symptoms and laboratory tests showed decreasing cytokine levels.
  
  
  CONCLUSIONS
  To our knowledge, this is the first report of TAFRO syndrome in a young patient, suggesting that this disease can occur even in adolescence. The patient was successfully treated with TCZ. During our patient's clinical course, monitoring cytokine profiles was useful to assess the disease activity of TAFRO syndrome.
authors.affiliation: Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-ku, Kobe 650-0017, Japan. ikuiku1979@gmail.com.
authors.forename: Ikuko
authors.initials: I
authors.lastname: Kubokawa
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yachie
authors.forename: Akira
authors.initials: A
authors.lastname: Hayakawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirase
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Mori
authors.forename: Tomoko
authors.initials: T
authors.lastname: Yanai
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Takeshima
authors.forename: Eiryu
authors.initials: E
authors.lastname: Kyo
authors.forename: Goichi
authors.initials: G
authors.lastname: Kageyama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nagai
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Uehara
authors.forename: Masaru
authors.initials: M
authors.lastname: Kojima
authors.forename: Kazumoto
authors.initials: K
authors.lastname: Iijima
mesh_terms: D058186:Acute Kidney Injury / Q000188:drug therapy / Q000209:etiology*; D000293:Adolescent; D000740:Anemia / Q000188:drug therapy / Q000209:etiology; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D001853:Bone Marrow / Q000473:pathology*; D002097:C-Reactive Protein / Q000032:analysis; D016207:Cytokines / Q000097:blood; D004487:Edema / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007019:Hypoproteinemia / Q000175:diagnosis; D007564:Japan; D008206:Lymphatic Diseases / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D055728:Primary Myelofibrosis / Q000175:diagnosis* / Q000188:drug therapy; D012131:Respiratory Insufficiency / Q000188:drug therapy / Q000209:etiology; D012155:Reticulin; D013577:Syndrome; D013921:Thrombocytopenia / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D016207:Cytokines; D012155:Reticulin; D002097:C-Reactive Protein; C502936:tocilizumab