title: Episodic fevers and vasodilatory shock mimicking urosepsis in a patient with HIV-associated multicentric Castleman's Disease: a case report.
abstract: BACKGROUND
  Multicentric Castleman's disease (MCD) is a pre-malignancy that presents with lymphadenopathy and features of systemic inflammation. Human immunodeficiency virus (HIV)-associated MCD is associated with human herpesvirus-8 (HHV-8) infection. If untreated MCD has a relapsing and remitting course that is eventually fatal.
  
  
  METHODS
  A 67-year-old man had six hospital admissions over 20 months characterised by fever, urinary frequency and CRP >100 mg/L. The final admission was complicated by hypotension requiring intensive care unit admission and ionotropic support. His history included HIV and Hepatitis B virus (HBV) co-infection on suppressive therapy. Each presentation was managed as presumed urosepsis with use of empirical antibiotics, however numerous blood and urine cultures failed to identify a pathogen. A bone-marrow aspirate and trephine found no evidence of haematological malignancy. A positron emission tomography scan found active lymph nodes, one of which was biopsied and found to contain the plasma-cell variant of Castleman's disease. Ultimately the cause for the recurrent presentations was attributed to progressive MCD. The patient received rituximab monotherapy and has had no further related admissions.
  
  
  CONCLUSIONS
  MCD should be considered in patients with chronic HIV infection presenting with recurrent sepsis-like episodes and/or vasodilatory shock, particularly if no pathogen is identified or lymphadenopathy is evident.
authors.affiliation: Clinical Immunology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia. sand6015@uni.sydney.edu.au.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Anderson
authors.affiliation: Clinical Immunology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia. ssas7805@med.usyd.edu.au.|Sydney Medical School, University of Sydney, Sydney, NSW, Australia. ssas7805@med.usyd.edu.au.|Level 6 Laboratory Services Building, Royal Prince Alfred Hospital, Missenden Rd Camperdown, Sydney, NSW, Australia. ssas7805@med.usyd.edu.au.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Sasson
authors.affiliation: Clinical Immunology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia. Frederick.Lee@sswahs.nsw.gov.au.|Sydney Medical School, University of Sydney, Sydney, NSW, Australia. Frederick.Lee@sswahs.nsw.gov.au.
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Lee
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, NSW, Australia. wendy.cooper@sydney.edu.au.|Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. wendy.cooper@sydney.edu.au.|School of Medicine, University of Western Sydney, Parramatta, NSW, Australia. wendy.cooper@sydney.edu.au.
authors.forename: Wendy
authors.initials: W
authors.lastname: Cooper
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, NSW, Australia. stephen.larsen@sswahs.health.nsw.gov.au.|Haematology Department Royal Prince Alfred Hospital, Sydney, NSW, Australia. stephen.larsen@sswahs.health.nsw.gov.au.
authors.forename: Stephen
authors.initials: S
authors.lastname: Larsen
authors.affiliation: Clinical Immunology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia. r.garsia@sydney.edu.au.|Sydney Medical School, University of Sydney, Sydney, NSW, Australia. r.garsia@sydney.edu.au.
authors.forename: Roger
authors.initials: R
authors.lastname: Garsia
mesh_terms: D000368:Aged; D005871:Castleman Disease / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D060085:Coinfection; D005334:Fever / Q000175:diagnosis*; D015658:HIV Infections / Q000150:complications*; D006509:Hepatitis B / Q000150:complications*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D000072281:Lymphadenopathy; D008297:Male; D000069283:Rituximab / Q000627:therapeutic use; D018805:Sepsis / Q000175:diagnosis*; D014552:Urinary Tract Infections / Q000175:diagnosis
chemical_list: D000069283:Rituximab
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