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Qiao Y, Zhang X, Xu R, Jia X, Wang Q. Delayed diagnosis of TAFRO syndrome: A case report. Medicine (Baltimore) 2024; 103:e39148. [PMID: 39093747 PMCID: PMC11296483 DOI: 10.1097/md.0000000000039148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 07/10/2024] [Indexed: 08/04/2024] Open
Abstract
RATIONALE TAFRO syndrome is a systemic inflammatory disorder, manifesting as thrombocytopenia (t), anasarca (a), fever (f), reticulin myelofibrosis/renal insufficiency (r), and organomegaly (o), and considered as a unique clinical subtype of idiopathic multicentric Castleman disease (iMCD). Such syndrome gave rise to a clinical picture similar to that of either a connective tissue disease or an autoimmune disease. PATIENT CONCERNS A Chinese young female initially presenting with arthralgia, Raynaud phenomenon, generalized edema, and a positive anti-small nuclear ribonucleoprotein particle antibody was diagnosed as mixed connective tissue disease. The kidney biopsy showed thrombotic microangiopathy. Bone marrow smear showed bone marrow hyperplasia and biopsy revealed suspected light chain restricted expression, megakaryocyte proliferation, and moderate to severe bone marrow fibrosis. A lymph node biopsy was conducted and the histopathological findings were consistent with the subtype of mixed Castleman disease. The clinical symptoms were relieved after regular chemotherapy. DIAGNOSES After above examination results and clinical manifestations, the final diagnoses was TAFRO syndrome. INTERVENTION The she was started on chemotherapy with bortezomib, cyclophosphamide, and dexamethasone. OUTCOME After chemotherapy, symptoms such as thrombocytopenia, hematuria and proteinuria disappeared, lymphadenopathy and VEGF level decreased, and bone marrow fibrosis relieved. LESSONS Our case illustrated the first cases of shared characteristics of mixed connective tissue disease and iMCD-TAFRO syndrome. Cytokines may play a role in the shared pathogenicity of the iMCD-TAFRO syndrome and systemic autoimmune diseases. Therapy directly against inflammatory factors such as corticosteroids or chemotherapy have an important therapeutic implication.
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Affiliation(s)
- Yumeng Qiao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Xin Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Rong Xu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Xiaoyu Jia
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Qian Wang
- Department of Hematology, Peking University First Hospital, Beijing, China
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Srkalovic G, Nijim S, Srkalovic MB, Fajgenbaum D. Increase in Vascular Endothelial Growth Factor (VEGF) Expression and the Pathogenesis of iMCD-TAFRO. Biomedicines 2024; 12:1328. [PMID: 38927535 PMCID: PMC11201201 DOI: 10.3390/biomedicines12061328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/31/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
TAFRO (thrombocytopenia (T), anasarca (A), fever (F), reticulin fibrosis (F/R), renal failure (R), and organomegaly (O)) is a heterogeneous clinical subtype of idiopathic multicentric Castleman disease (iMCD) associated with a significantly poorer prognosis than other subtypes of iMCD. TAFRO symptomatology can also be seen in pathological contexts outside of iMCD, but it is unclear if those cases should be considered representative of a different disease entity or simply a severe presentation of other infectious, malignant, and rheumatological diseases. While interleukin-6 (IL-6) is an established driver of iMCD-TAFRO pathogenesis in a subset of patients, the etiology is unknown. Recent case reports and literature reviews on TAFRO patients suggest that vascular endothelial growth factor (VEGF), and the interplay of VEGF and IL-6 in concert, rather than IL-6 as a single cytokine, may be drivers for iMCD-TAFRO pathophysiology, especially renal injury. In this review, we discuss the possible role of VEGF in the pathophysiology and clinical manifestations of iMCD-TAFRO. In particular, VEGF may be involved in iMCD-TAFRO pathology through its ability to activate RAS/RAF/MEK/ERK and PI3K/AKT/mTOR signaling pathways. Further elucidating a role for the VEGF-IL-6 axis and additional disease drivers may shed light on therapeutic options for the treatment of TAFRO patients who do not respond to, or otherwise relapse following, treatment with IL-6 targeting drugs. This review investigates the potential role of VEGF in the pathophysiology of iMCD-TAFRO and the potential for targeting related signaling pathways in the future.
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Affiliation(s)
- Gordan Srkalovic
- Herbert-Herman Cancer Center, University of Michigan Health-Sparrow, Lansing, MI 48912, USA
| | - Sally Nijim
- Center for Cytokine Storm Treatment & Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (S.N.); (D.F.)
| | | | - David Fajgenbaum
- Center for Cytokine Storm Treatment & Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (S.N.); (D.F.)
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Mimura Y, Kojima K, Fujikawa A, Okada S, Fujimori A, Kuma A, Kuragano T. A case of TAFRO syndrome after vaccination, successfully treated with cyclosporine. BMC Nephrol 2024; 25:196. [PMID: 38872134 PMCID: PMC11177486 DOI: 10.1186/s12882-024-03630-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 06/07/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND TAFRO syndrome is a rare disorder that causes thrombocytopenia, generalized oedema, fever, organ enlargement, and renal impairment. Few reports have suggested an association with vaccines, and few cases have undergone renal biopsy. TAFRO syndrome is often severe and fatal, and its cause is unknown. We report a case of TAFRO syndrome that occurred after vaccination with the coronavirus disease 2019 (COVID-19) vaccine. CASE PRESENTATION An 82-year-old woman received two doses of the BNT162b2 mRNA vaccine 3 weeks apart. Two weeks later, she was admitted to the hospital with oedema, accompanied with renal failure and thrombocytopenia. After close examination, she was diagnosed with TAFRO syndrome. She was treated with steroids, cyclosporine, and thrombopoietin receptor agonists. The patient was discharged after several months in remission. CONCLUSIONS Although an incident of TAFRO syndrome after COVID-19 vaccination has been previously reported, this is a rare case in which the patient went into remission and was discharged. A renal biopsy was also performed in this case, which was consistent with previous reports. The favorable treatment course for TAFRO syndrome provides valuable insights.
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Affiliation(s)
- Yasuyuki Mimura
- Department of Cardiovascular and Renal Medicine, Hyogo Medical University, 1-1 Mukogawa-Cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Katsuhito Kojima
- Department of Nephrology, Konan Medical Center, 1-5-16 Kamokogahara, Higashinada-Ku, Kobe, Hyogo, 658-0064, Japan
| | - Arisa Fujikawa
- Department of Nephrology, Konan Medical Center, 1-5-16 Kamokogahara, Higashinada-Ku, Kobe, Hyogo, 658-0064, Japan
| | - Shioko Okada
- Department of Nephrology, Konan Medical Center, 1-5-16 Kamokogahara, Higashinada-Ku, Kobe, Hyogo, 658-0064, Japan
| | - Akira Fujimori
- Department of Nephrology, Konan Medical Center, 1-5-16 Kamokogahara, Higashinada-Ku, Kobe, Hyogo, 658-0064, Japan
| | - Akihiro Kuma
- Department of Cardiovascular and Renal Medicine, Hyogo Medical University, 1-1 Mukogawa-Cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Takahiro Kuragano
- Department of Cardiovascular and Renal Medicine, Hyogo Medical University, 1-1 Mukogawa-Cho, Nishinomiya, Hyogo, 663-8501, Japan
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Shirai T, Ichikawa S, Saegusa J. Tacrolimus Treatment for TAFRO Syndrome. Biomedicines 2024; 12:1070. [PMID: 38791031 PMCID: PMC11118940 DOI: 10.3390/biomedicines12051070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
TAFRO syndrome is an acute systemic inflammatory disorder characterized by thrombocytopenia, anasarca, fever, reticulin myelofibrosis, renal dysfunction, and organomegaly. While its lymph node pathology is similar to that of idiopathic multicentric Castleman disease (iMCD), the clinical features of TAFRO syndrome differ from those of typical iMCD, as they include a more aggressive clinical course and high mortality. However, an optimal treatment strategy for TAFRO syndrome has not yet been established, owing to a poor understanding of its pathogenesis. The limited cases we encountered suggest that tacrolimus treatment in combination with glucocorticoids may potentially be effective and well tolerated as an initial treatment, and hold promise as a glucocorticoid-sparing agent. Herein, we report an additional case and review the sparse literature available regarding TAFRO syndrome treated via tacrolimus.
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Affiliation(s)
- Taiichiro Shirai
- Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
- Laboratory of Immune Response Dynamics, WPI Immunology Frontier Research Center, Osaka University, Osaka 565-0871, Japan
- Department of Immune Response Dynamics, Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan
| | - Shinya Ichikawa
- Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Jun Saegusa
- Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
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Ide M, Yokoyama T, Ishikawa M, Kojima K. Stepwise Treatment for TAFRO Syndrome. J Med Cases 2023; 14:369-377. [PMID: 38029058 PMCID: PMC10681766 DOI: 10.14740/jmc4160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
TAFRO syndrome, a rapidly progressive and fatal disease, is rare, and its etiology remains unknown. It is characterized by thrombocytopenia, anasarca (edema, pleural effusion, and ascites), fever, reticulin fibrosis (or renal insufficiency), and organomegaly with Castleman disease (CD)-like histological features in the lymph nodes. CD is a rare, indolent, lymphoproliferative disorder with no established curative strategies. Most idiopathic multicentric CD cases are controlled with anti-interleukin (IL)-6 therapy (tocilizumab and siltuximab) and/or rituximab. However, it is unclear whether these therapies can be directly applied to treat TAFRO syndrome. Here, we describe stepwise immunotherapy (rituximab induction therapy and cyclosporine maintenance therapy) for two cases of steroid-refractory TAFRO syndrome. A 32-year-old man visited a local hospital with sudden onset of fever and epigastralgia. The diagnosis of TAFRO syndrome was established based on the diagnostic criteria. After rituximab administration, C-reactive protein and IL-6 levels were normalized. However, the ascites persisted, with increased resistance to rituximab. Tocilizumab was also ineffective; therefore, cyclosporine was administered. After the initiation of cyclosporine treatment, the ascites decreased and ultimately disappeared. Twelve months after immunotherapy, the patient remained asymptomatic under cyclosporine maintenance therapy. Similar stepwise immunosuppressive therapy was administered to a 72-year-old man with TAFRO syndrome complicated by renal failure. After rituximab infusion, C-reactive protein was decreased. Although methylprednisolone, rituximab, tocilizumab, and cyclosporine were administered, other laboratory data and clinical symptoms remained unchanged. His level of consciousness subsequently deteriorated due to herpes zoster encephalitis, and he died. We consider the combination of rituximab induction therapy and cyclosporine maintenance therapy to be effective for TAFRO syndrome if initiated at an early stage.
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Affiliation(s)
- Makoto Ide
- Department of Hematology, Takamatsu Red Cross Hospital, Takamatsu, Kagawa, Japan
| | - Tomoko Yokoyama
- Department of Nephrology, Takamatsu Red Cross Hospital, Takamatsu, Kagawa, Japan
| | - Masashi Ishikawa
- Department of Pathology, Takamatsu Red Cross Hospital, Takamatsu, Kagawa, Japan
| | - Kazuki Kojima
- Takamatsu Red Cross Hospital Post Graduate Clinical Training Center, Takamatsu Red Cross Hospital, Takamatsu, Kagawa, Japan
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Yamamoto S, Wells K, Morita K, Tanigaki K, Muro K, Matsumoto M, Nakai H, Arai Y, Akizuki S, Takahashi K, Minamiguchi S, Fukuma S, Yanagita M. Severe TAFRO Syndrome Mimicking Hepatorenal Syndrome Successfully Treated with a Multidisciplinary Approach: A Case Report and Literature Review. Intern Med 2023; 62:2715-2724. [PMID: 36725034 PMCID: PMC10569924 DOI: 10.2169/internalmedicine.1178-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/19/2022] [Indexed: 02/03/2023] Open
Abstract
Finding the ideal balance between efficacy and safety of immunosuppression is challenging, particularly in cases of severe TAFRO syndrome. We herein report a 60-year-old man diagnosed with grade 5 TAFRO syndrome mimicking hepatorenal syndrome that was successfully treated by glucocorticoid, tocilizumab, and cyclosporin despite virus infection. Furthermore, by examining 14 peer-reviewed remission cases, we revealed that the recovery periods among inflammation, renal dysfunction, and thrombocytopenia were quite different, with recovery from thrombocytopenia notably slow. All patients requiring dialysis were successfully withdrawn from dialysis, and the reversibility from kidney injury was good. This clinical information will help clinicians plan treatments and tailor the intensity of immunosuppression.
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Affiliation(s)
- Shinya Yamamoto
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Japan
| | - Ken Wells
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Japan
| | - Keisuke Morita
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Japan
| | - Katsuya Tanigaki
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Japan
- Department of Nephrology, Kansai Denryoku Hospital, Japan
| | - Koji Muro
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Japan
| | - Minami Matsumoto
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Japan
| | - Hirotsugu Nakai
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Japan
- Department of Radiology, Tenri Hospital, Japan
| | - Yasuyuki Arai
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Japan
| | - Shuji Akizuki
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Japan
| | - Ken Takahashi
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Japan
| | - Sachiko Minamiguchi
- Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Japan
| | - Shingo Fukuma
- Human and Health Sciences, Graduate School of Medicine, Kyoto University, Japan
| | - Motoko Yanagita
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Japan
- Institute for the Advanced Study of Human Biology (WPI-ASHBi), Kyoto University, Japan
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Rosenstiel P, Luitel D, Luna M. A Patient Presenting with AKI, Proteinuria, and Anasarca. KIDNEY360 2023; 4:287-288. [PMID: 36821621 PMCID: PMC10103363 DOI: 10.34067/kid.0000000000000034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/06/2022] [Indexed: 02/24/2023]
Affiliation(s)
- Paul Rosenstiel
- South Texas Pathology Associates, Methodist Specialty and Transplant Hospital, San Antonio, Texas
| | - Deepa Luitel
- Methodist Specialty and Transplant Hospital, San Antonio, Texas
| | - Maria Luna
- San Antonio Kidney, Methodist Hospital, San Antonio, Texas
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Iwasaki T, Mizusaki K, Masumoto M, Minagawa Y, Azuma K, Furukawa T, Yoshida M, Kuragano T. TAFRO syndrome with renal biopsy successfully treated with steroids and cyclosporine: a case report. BMC Nephrol 2022; 23:262. [PMID: 35870879 PMCID: PMC9308189 DOI: 10.1186/s12882-022-02886-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 07/13/2022] [Indexed: 12/27/2022] Open
Abstract
Abstract
Background
TAFRO syndrome is an acute or subacute systemic inflammatory disease with no apparent cause, presenting with fever, generalized edema, thrombocytopenia, renal damage, anemia, and organ enlargement. Interleukin-6, vascular endothelial growth factor, and other cytokines are thought to be the etiologic agents that increase vascular permeability and cause the resulting organ damage. Only few reports of renal biopsy performed in patients with TAFRO syndrome exist.
Case presentation
A 61-year-old woman, with a history of Sjogren’s syndrome, was admitted to our hospital with anasarca and abdominal distension. Based on the clinical course and various laboratory findings, we diagnosed TAFRO syndrome. Renal biopsy revealed thrombotic microangiopathy, including endothelial cell swelling, subendothelial space expansion, and mesangiolysis. She was treated with oral prednisolone and cyclosporine, with consequent resolution of anasarca, pleural effusion, and ascites, and improvement in renal function and urinary findings. The patient’s platelet count also normalized after 2 months of treatment.
Conclusions
Given that only few reports of improvement in the systemic symptoms of TAFRO syndrome using steroids and cyclosporine exist, our study investigating the relationship between the pathogenesis of TAFRO syndrome and renal disorders, as well as treatment methods, provides valuable insights.
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Inoue K, Nagai K, Tsukada T, Iwase M, Sakata A, Ueda A, Yamagata K. POEMS Syndrome with Biclonal Gammopathy and Renal Involvement. Intern Med 2022; 61:2191-2196. [PMID: 35283379 PMCID: PMC9381336 DOI: 10.2169/internalmedicine.8714-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Polyneuropathy, Organomegaly, Endocrinopathy, M-protein and Skin changes (POEMS) syndrome manifests as elevated levels of vascular endothelial growth factor (VEGF) and monoclonal gammopathy. We treated a case of POEMS syndrome showing monoclonality in both IgA-λ and IgG-κ. Serial renal biopsies before treatment and after normalization of the VEGF levels suggested that glomerular microangiopathy had developed due to VEGF, while biclonal gammopathy was not eliminated. The renal pathology, proteinuria, and renal function all clearly improved. Although severe polyneuropathy limited activities of daily living and enforced a bedridden state, the patient dramatically regained his motor function, achieving crutch walking after induction of remission. This case is highly notable due to the presence of biclonality and repeated biopsies.
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Affiliation(s)
- Kohei Inoue
- Department of Nephrology, Hitachi General Hospital, Japan
| | - Kei Nagai
- Department of Nephrology, Hitachi General Hospital, Japan
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Japan
| | | | - Mamiko Iwase
- Department of Nephrology, Hitachi General Hospital, Japan
| | - Akiko Sakata
- Department of Pathology, Hitachi General Hospital, Japan
| | - Atsushi Ueda
- Department of Nephrology, Hitachi General Hospital, Japan
| | - Kunihiro Yamagata
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Japan
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Nagai M, Uchida T, Yamada M, Komatsu S, Ota K, Mukae M, Iwamoto H, Hirano H, Karube M, Kaname S, Oda T. TAFRO Syndrome in a Kidney Transplant Recipient That Was Diagnosed on Autopsy: A Case Report. Front Med (Lausanne) 2021; 8:747678. [PMID: 34671626 PMCID: PMC8520974 DOI: 10.3389/fmed.2021.747678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/06/2021] [Indexed: 01/09/2023] Open
Abstract
A 57-year-old man who received a kidney transplant 4 years previously owing to unknown underlying disease presented with thrombocytopenia and fever. Hepatosplenomegaly and lymphadenopathy were observed, and development of prominent anasarca and worsening of renal function yielded the diagnosis of TAFRO syndrome. He was treated with high-dose steroids and plasmapheresis, and a thrombopoietin receptor agonist was administered for refractory thrombocytopenia. However, his general condition worsened, and he died on day 92. Histopathological analysis of a kidney autopsy specimen showed thrombotic microangiopathy characterized by glomerular endothelial swelling, mesangiolysis, and double contours of the glomerular capillary walls. His bone marrow showed megakaryocytic hyperplasia with mild reticulin fibrosis. Interestingly, these clinical and pathological features were remarkably similar to those the patient demonstrated before the kidney transplant, suggesting the recurrence of TAFRO syndrome. TAFRO syndrome is a rare systemic disorder whose concept has recently been established, but information on its long-term outcome is scarce. To our knowledge, this is the first case of TAFRO syndrome developing in a kidney transplant recipient, which suggests that disease recurrence occurs many years after the kidney transplant.
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Affiliation(s)
- Marie Nagai
- Department of Nephrology and Blood Purification, Kidney Disease Center, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Takahiro Uchida
- Department of Nephrology and Blood Purification, Kidney Disease Center, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Muneharu Yamada
- Department of Nephrology and Blood Purification, Kidney Disease Center, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Shuuhei Komatsu
- Department of Nephrology and Blood Purification, Kidney Disease Center, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Kohei Ota
- Department of Nephrology and Blood Purification, Kidney Disease Center, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Mitsuya Mukae
- Department of Nephrology and Blood Purification, Kidney Disease Center, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Hitoshi Iwamoto
- Department of Kidney Transplantation Surgery, Kidney Disease Center, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Hiroshi Hirano
- Departmet of Diagnostic Pathology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Miho Karube
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Shinya Kaname
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Takashi Oda
- Department of Nephrology and Blood Purification, Kidney Disease Center, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
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Akagi Y, Kato T, Yamashita Y, Hosoi H, Murata S, Yamamoto S, Warigaya K, Nakao T, Murata S, Sonoki T, Tamura S. Intracranial Hemorrhage in a Patient with TAFRO Syndrome Treated with Cyclosporine A and Rituximab. ACTA ACUST UNITED AC 2021; 57:medicina57090971. [PMID: 34577894 PMCID: PMC8464675 DOI: 10.3390/medicina57090971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/16/2022]
Abstract
TAFRO syndrome, a rare subtype of idiopathic multicentric Castleman disease, manifests as thrombocytopenia, anasarca, fever, reticulin fibrosis, and organomegaly. Thrombotic microangiopathy, including renal dysfunction, is frequently associated with this syndrome. TAFRO syndrome can be life threatening and show rapid progression, and the diagnosis and management of this disorder remain challenging. A 48-year-old woman was diagnosed with TAFRO syndrome complicated by thrombotic microangiopathy based on the clinical and histopathological findings. After receiving high-dose steroids, her thrombocytopenia and anasarca did not improve. The patient subsequently received a combination of cyclosporine A and rituximab as second-line therapy, which resulted in a significant gradual improvement in the clinical symptoms. Meanwhile, her platelet count increased to more than 40 × 109/L; however, she developed intracranial hemorrhage. Following surgical evacuation, the patient recovered with an achievement of sustained remission. Based on these findings, attention should be paid to life-threatening bleeding associated with local thrombotic microangiopathy even when intensive treatment is administered for TAFRO syndrome.
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Affiliation(s)
- Yuina Akagi
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 6418509, Japan; (Y.A.); (T.K.); (Y.Y.); (H.H.); (S.M.); (T.S.)
- Department of Internal Medicine, Naga Municipal Hospital, Wakayama 6496414, Japan;
| | - Takashi Kato
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 6418509, Japan; (Y.A.); (T.K.); (Y.Y.); (H.H.); (S.M.); (T.S.)
| | - Yusuke Yamashita
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 6418509, Japan; (Y.A.); (T.K.); (Y.Y.); (H.H.); (S.M.); (T.S.)
- Department of Internal Medicine, Naga Municipal Hospital, Wakayama 6496414, Japan;
| | - Hiroki Hosoi
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 6418509, Japan; (Y.A.); (T.K.); (Y.Y.); (H.H.); (S.M.); (T.S.)
| | - Shogo Murata
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 6418509, Japan; (Y.A.); (T.K.); (Y.Y.); (H.H.); (S.M.); (T.S.)
| | - Shuto Yamamoto
- Department of Nephrology, Wakayama Medical University, Wakayama 6418509, Japan;
| | - Kenji Warigaya
- Department of Diagnostic Pathology, Wakayama Medical University, Wakayama 6418509, Japan; (K.W.); (S.M.)
| | - Taisei Nakao
- Department of Internal Medicine, Naga Municipal Hospital, Wakayama 6496414, Japan;
| | - Shinichi Murata
- Department of Diagnostic Pathology, Wakayama Medical University, Wakayama 6418509, Japan; (K.W.); (S.M.)
| | - Takashi Sonoki
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 6418509, Japan; (Y.A.); (T.K.); (Y.Y.); (H.H.); (S.M.); (T.S.)
| | - Shinobu Tamura
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 6418509, Japan; (Y.A.); (T.K.); (Y.Y.); (H.H.); (S.M.); (T.S.)
- Correspondence: ; Tel.: +81-73-441-0665; Fax: +81-73-441-0653
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Shibata S, Tabata S, Morita H, Endo T, Kawasaki N, Okamoto Y, Inano S, Takiuchi Y, Fukunaga A, Kitano T. Borderline Case of TAFRO Syndrome and POEMS Syndrome. Intern Med 2021; 60:1589-1595. [PMID: 33328401 PMCID: PMC8188039 DOI: 10.2169/internalmedicine.5860-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
TAFRO syndrome and POEMS syndrome are lymphoproliferative disorders with elevated interleukin-6 and vascular endothelial growth factor (VEGF) levels; however, their underlying pathogenic mechanisms remain unclear. Similarities have been reported in the pathological findings of the lymph nodes of TAFRO syndrome, Multicentric Castleman disease (MCD), and some cases of POEMS syndrome. However, there is no consensus on the relationship among them. We encountered a case of lymphoproliferative disorder that presented with manifestations of both TAFRO syndrome and POEMS syndrome. This case may be a subtype of idiopathic MCD and will be very important for establishing the disease concept of TAFRO syndrome and POEMS syndrome.
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Affiliation(s)
- Sho Shibata
- Department of Hematology, Tazuke Kofukai, Medical Research Institute, Kitano Hospital, Japan
| | - Sumie Tabata
- Department of Hematology, Tazuke Kofukai, Medical Research Institute, Kitano Hospital, Japan
| | - Hajime Morita
- Department of Nephrology, Tazuke Kofukai, Medical Research Institute, Kitano Hospital, Japan
| | - Tomomi Endo
- Department of Nephrology, Tazuke Kofukai, Medical Research Institute, Kitano Hospital, Japan
| | - Naoto Kawasaki
- Department of Hematology, Tazuke Kofukai, Medical Research Institute, Kitano Hospital, Japan
| | - Yoshio Okamoto
- Department of Hematology, Tazuke Kofukai, Medical Research Institute, Kitano Hospital, Japan
| | - Shojiro Inano
- Department of Hematology, Tazuke Kofukai, Medical Research Institute, Kitano Hospital, Japan
| | - Yoko Takiuchi
- Department of Hematology, Tazuke Kofukai, Medical Research Institute, Kitano Hospital, Japan
| | - Akiko Fukunaga
- Department of Hematology, Tazuke Kofukai, Medical Research Institute, Kitano Hospital, Japan
| | - Toshiyuki Kitano
- Department of Hematology, Tazuke Kofukai, Medical Research Institute, Kitano Hospital, Japan
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13
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Kawabata H, Fujimoto S, Sakai T, Yanagisawa H, Kitawaki T, Nara K, Hagihara M, Yamamoto H, Tanimizu M, Kato C, Origuchi T, Sunami K, Sunami Y, Masunari T, Nakamura N, Kobayashi M, Yamagami K, Miura K, Takai K, Aoki S, Tsukamoto N, Masaki Y. Patient's age and D-dimer levels predict the prognosis in patients with TAFRO syndrome. Int J Hematol 2021; 114:179-188. [PMID: 33929719 PMCID: PMC8085640 DOI: 10.1007/s12185-021-03159-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 11/26/2022]
Abstract
Objectives To identify prognostic factors for TAFRO syndrome, a rare inflammatory disorder of unknown etiology characterized by thrombocytopenia, anasarca, fever, reticulin myelofibrosis, renal dysfunction, and organomegaly. Methods Data of patients with TAFRO syndrome were extracted from a Japanese patient registry. Patients were divided into groups according to the clinical and laboratory parameters at initial presentation. Cut-off values for the laboratory parameters were determined using receiver operating characteristic curve analysis and by clinical relevance. Patient survival was analyzed by the Kaplan–Meier method. Univariable analysis was performed using log-rank tests. Multivariable analyses were performed with the logistic regression model and the Cox proportional hazards model. Results We extracted the data of 83 patients with TAFRO syndrome from the registry. Univariable analysis identified several potential prognostic factors. Of these factors, age ≥60 years and D-dimer ≥18 μg/dL remained significant predictors of poor overall survival in the multivariable Cox proportional hazards model. Based on these results, we developed a simple prognostic scoring system for TAFRO syndrome (TS-PSS). Conclusion Patients in our cohort were stratified into low, intermediate, and high-risk groups by the TS-PSS. This system should be verified with independent patient cohorts in future studies. Supplementary Information The online version contains supplementary material available at 10.1007/s12185-021-03159-x.
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Affiliation(s)
- Hiroshi Kawabata
- Department of Hematology and Immunology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa-ken, 920-0293, Japan.
| | - Shino Fujimoto
- Department of Hematology and Immunology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa-ken, 920-0293, Japan
| | - Tomoyuki Sakai
- Department of Hematology and Immunology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa-ken, 920-0293, Japan
| | - Hiroto Yanagisawa
- Department of Hematology and Immunology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa-ken, 920-0293, Japan
| | - Toshio Kitawaki
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenji Nara
- Department of Hematology, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Masao Hagihara
- Department of Hematology, Eiju General Hospital, Tokyo, Japan
| | - Hiroshi Yamamoto
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masakuni Tanimizu
- Department of Internal Medicine, Tottori Municipal Hospital, Tottori, Japan
| | - Chikako Kato
- Department of General Internal Medicine, Toyota Kosei Hospital, Toyota, Japan
| | - Tomoki Origuchi
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Kazutaka Sunami
- Department of Hematology, NHO Okayama Medical Center, Okayama, Japan
| | - Yoshitaka Sunami
- Department of Hematology, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Taro Masunari
- Department of Infectious Disease, Chugoku Central Hospital, Fukuyama, Japan
| | - Nobuhiko Nakamura
- Department of Hematology, Gifu University Graduate School of Medicine, Gifu, Japan
| | | | - Keiko Yamagami
- Department of Internal Medicine, Osaka City General Hospital, Osaka, Japan
| | - Katsuhiro Miura
- Division of Hematology and Rheumatology, Department of Internal Medicine, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Kazue Takai
- Department of Hematology, Niigata City General Hospital, Niigata, Japan
| | - Sadao Aoki
- Department of Pathophysiology, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences, Niigata, Japan
| | | | - Yasufumi Masaki
- Department of Hematology and Immunology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa-ken, 920-0293, Japan
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14
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Renal Diseases Associated with Hematologic Malignancies and Thymoma in the Absence of Renal Monoclonal Immunoglobulin Deposits. Diagnostics (Basel) 2021; 11:diagnostics11040710. [PMID: 33921123 PMCID: PMC8071536 DOI: 10.3390/diagnostics11040710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/02/2021] [Accepted: 04/13/2021] [Indexed: 12/05/2022] Open
Abstract
In addition to kidney diseases characterized by the precipitation and deposition of overproduced monoclonal immunoglobulin and kidney damage due to chemotherapy agents, a broad spectrum of renal lesions may be found in patients with hematologic malignancies. Glomerular diseases, in the form of paraneoplastic glomerulopathies and acute kidney injury with various degrees of proteinuria due to specific lymphomatous interstitial and/or glomerular infiltration, are two major renal complications observed in the lymphoid disorder setting. However, other hematologic neoplasms, including chronic lymphocytic leukemia, thymoma, myeloproliferative disorders, Castleman disease and hemophagocytic syndrome, have also been associated with the development of kidney lesions. These renal disorders require prompt recognition by the clinician, due to the need to implement specific treatment, depending on the chemotherapy regimen, to decrease the risk of subsequent chronic kidney disease. In the context of renal disease related to hematologic malignancies, renal biopsy remains crucial for accurate pathological diagnosis, with the aim of optimizing medical care for these patients. In this review, we provide an update on the epidemiology, clinical presentation, pathophysiological processes and diagnostic strategy for kidney diseases associated with hematologic malignancies outside the spectrum of monoclonal gammopathy of renal significance.
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15
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Sato T, Ono Y, Matsushima J, Fujii A, Sato Y, Hidaka Y, Kawamoto S, Yoshino A, Takeda T, Ueda Y, Ban S. Histopathologic findings of TAFRO syndrome with immunohistochemical analysis of the kidney specimen: A case report. HUMAN PATHOLOGY: CASE REPORTS 2021. [DOI: 10.1016/j.ehpc.2020.200471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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16
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Shimada K, Sasaki T, Okabe M, Koike K, Takahashi D, Terashima R, Honda Y, Matsumoto N, Fukui A, Ishikawa M, Tsuboi N, Yokoo T. TAFRO Syndrome With Kidney Involvement: A Case Series of Patients With Kidney Biopsies. Kidney Med 2021; 3:286-293. [PMID: 33851125 PMCID: PMC8039406 DOI: 10.1016/j.xkme.2020.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
TAFRO (thrombocytopenia, anasarca, fever, reticulin myelofibrosis/renal insufficiency, and organomegaly) syndrome is a systemic inflammatory disease sharing some features with Castleman disease and POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes) syndrome in relation to abnormal secretions of interleukin 6 and vascular endothelial growth factor. The kidney is a main target organ of TAFRO syndrome but the kidney histopathology associated with TAFRO syndrome is yet to be completely defined. We report 3 TAFRO syndrome cases with different clinical courses in which kidney biopsies were performed. In all 3 cases, kidney biopsies showed similar glomerular lesions of diffuse global swelling of the endothelium and expansion of subendothelial spaces, consistent with severe glomerular endothelial injury. Case 3 showed an additional finding of focal tubulointerstitial injury characterized by marked plasma cell infiltration, which was absent in the other 2 cases. Clinical symptoms in cases 1 and 2, which had lower disease severity scores of TAFRO syndrome, were effectively treated with the administration of corticosteroids or a combination of corticosteroids and cyclosporine A. Case 3, with a higher disease severity score, had an aggressive clinical course that was refractory to corticosteroids and tocilizumab; the patient ultimately died of multiple organ failure. In all 3 cases, kidney biopsy provided indications for the diagnosis process and clinical management of TAFRO syndrome.
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Affiliation(s)
- Keiki Shimada
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.,Department of Nephrology, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Takaya Sasaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.,Department of Nephrology, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Masahiro Okabe
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kentaro Koike
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Daisuke Takahashi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Risa Terashima
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yu Honda
- Department of Nephrology, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Naoto Matsumoto
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Akira Fukui
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Masahiro Ishikawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.,Department of Nephrology, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Nobuo Tsuboi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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17
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Semenchuk J, Merchant A, Sakhdari A, Kukreti V. Five biopsies, one diagnosis: challenges in idiopathic multicentric Castleman disease. BMJ Case Rep 2020; 13:13/11/e236654. [PMID: 33229481 DOI: 10.1136/bcr-2020-236654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A previously healthy 29-year-old man initially presented to the hospital with pleuritic chest pain and shortness of breath. Over the next 2 months he developed ongoing fevers and night sweats with recurrent exudative pleural effusions and ascites. He had an extensive infectious and autoimmune workup that was unremarkable. He had an initial lymph node biopsy that showed reactive changes only. He had an acute kidney injury and his renal biopsy revealed thrombotic microangiopathy. His liver biopsy showed non-specific inflammatory changes. His bone marrow biopsy showed megakaryocyte hyperplasia and fibrosis, which raised suspicion for the thrombocytopenia, ascites, reticulin fibrosis, renal dysfunction and organomegaly syndrome subtype of multicentric Castleman disease. This prompted a repeat lymph node biopsy, showing changes consistent with mixed type Castleman disease that fit with his clinical picture. He was initiated on steroids and siltuximab with significant clinical improvement.
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Affiliation(s)
- Julie Semenchuk
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Asad Merchant
- Department of Medicine, Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - Ali Sakhdari
- Department of Laboratory Medicine & Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Vishal Kukreti
- Department of Medicine, Medical Oncology & Hematology, University of Toronto, Toronto, Ontario, Canada
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18
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Tocilizumab for the treatment of TAFRO syndrome: a systematic literature review. Ann Hematol 2020; 99:2463-2475. [DOI: 10.1007/s00277-020-04275-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/17/2020] [Indexed: 02/07/2023]
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19
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Nagayama Y, Isoo N, Nakashima A, Suzuki K, Yamano M, Nariyama T, Yagame M, Matsui K. Renoprotective effects of paramylon, a β-1,3-D-Glucan isolated from Euglena gracilis Z in a rodent model of chronic kidney disease. PLoS One 2020; 15:e0237086. [PMID: 32764782 PMCID: PMC7413521 DOI: 10.1371/journal.pone.0237086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 07/20/2020] [Indexed: 12/25/2022] Open
Abstract
Paramylon is a novel β-glucan that is stored by Euglena gracilis Z, which is a unicellular photosynthesizing green alga with characteristics of both animals and plants. Recent studies have indicated that paramylon functions as an immunomodulator or a dietary fiber. Currently, chronic kidney disease (CKD) is a global health problem, and there is no effective preventive treatment for CKD progression. However, paramylon may suppress the progression of CKD via the elimination of uremic toxins or modulation of gut microbiota, leading to the alleviation of inflammation. The aim of this study was to evaluate the effect of paramylon in CKD rat model. Eight-week-old male Wistar rats with a 5/6 nephrectomy were given either a normal diet or a diet containing 5% paramylon for 8 weeks. Proteinuria was measured intermittently. Serum and kidney tissues were harvested after sacrifice. We performed a renal molecular and histopathological investigation, serum metabolome analysis, and gut microbiome analysis. The results showed that paramylon attenuated renal function, glomerulosclerosis, tubulointerstitial injury, and podocyte injury in the CKD rat model. Renal fibrosis, tubulointerstitial inflammatory cell infiltration, and proinflammatory cytokine gene expression levels tended to be suppressed with paramylon treatment. Further, paramylon inhibited the accumulation of uremic toxins, including tricarboxylic acid (TCA) cycle-related metabolites and modulated a part of CKD-related gut microbiota in the CKD rat model. In conclusion, we suggest that paramylon mainly inhibited the absorption of non-microbiota-derived uremic solutes, leading to protect renal injury via anti-inflammatory and anti-fibrotic effects. Paramylon may be a novel compound that can act against CKD progression.
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Affiliation(s)
- Yoshikuni Nagayama
- Department of Internal Medicine IV, Teikyo University School of Medicine, University Hospital, Mizonokuchi, Kawasaki, Japan
- * E-mail:
| | - Naoyuki Isoo
- Department of Internal Medicine IV, Teikyo University School of Medicine, University Hospital, Mizonokuchi, Kawasaki, Japan
| | | | | | - Mizuki Yamano
- Department of Internal Medicine IV, Teikyo University School of Medicine, University Hospital, Mizonokuchi, Kawasaki, Japan
| | - Tomoyuki Nariyama
- Department of Internal Medicine IV, Teikyo University School of Medicine, University Hospital, Mizonokuchi, Kawasaki, Japan
| | - Motoka Yagame
- Department of Internal Medicine IV, Teikyo University School of Medicine, University Hospital, Mizonokuchi, Kawasaki, Japan
| | - Katsuyuki Matsui
- Department of Internal Medicine IV, Teikyo University School of Medicine, University Hospital, Mizonokuchi, Kawasaki, Japan
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20
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Yamaguchi Y, Maeda Y, Shibahara T, Nameki S, Nakabayashi A, Komuta K, Mizuno Y, Yagita M, Manabe Y, Morita T, Nishide M, Watanabe A, Takamatsu H, Nishida S, Hirano T, Shima Y, Narazaki M, Kumanogoh A. Recovery from prolonged thrombocytopenia in patients with TAFRO syndrome: case series and literature review. Mod Rheumatol Case Rep 2020; 4:302-309. [PMID: 33087016 DOI: 10.1080/24725625.2020.1717747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
TAFRO syndrome is a newly proposed disease that is characterised by thrombocytopenia, anasarca, fever, reticulin fibrosis (or renal dysfunction), and organomegaly. Generally, high doses of corticosteroids are recommended for the initial treatment of TAFRO syndrome; however, some patients experience prolonged refractory thrombocytopenia after initiating such therapies. If corticosteroid treatment alone is ineffective, additional immunosuppressive therapies such as cyclosporine A are recommended. Since long-term use of immunosuppressive therapies with TAFRO syndrome sometimes causes serious infection, it is important to recognise the time to recovery from thrombocytopenia. In this study, we investigated how long it took to recover from thrombocytopenia, to aid clinicians in decision-making regarding the need to strengthen treatment for prolonged thrombocytopenia. Here, we describe three of our patients with TAFRO syndrome exhibiting prolonged thrombocytopenia. We also investigated the median period to recovery from this complication (defined as the time to increase the platelet count above 50,000/µL) after the initiation of high-dose corticosteroid treatment in our 3 cases and 38 peer-reviewed cases. We found that it took our patients 61 days to recover from thrombocytopenia; in comparison, our investigation of the 38 peer-reviewed case reports revealed a median recovery time of 47.5 days among previously reported patients. We showed the time to recovery from thrombocytopenia in patients with TAFRO syndrome for the first time. Our findings ought to be useful for decision-making among clinicians regarding the administration of other immunosuppressive treatments in addition to corticosteroid.
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Affiliation(s)
- Yuta Yamaguchi
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuichi Maeda
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takayuki Shibahara
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shinichiro Nameki
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Akihiko Nakabayashi
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kiyohide Komuta
- Postgraduate Medical Training Center, Osaka University Medical Hospital, Osaka, Japan
| | - Yumiko Mizuno
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Mayu Yagita
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yusuke Manabe
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takayoshi Morita
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Masayuki Nishide
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Akane Watanabe
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan.,Thermo-Therapeutics for Vascular Dysfunction, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hyota Takamatsu
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Sumiyuki Nishida
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Toru Hirano
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yoshihito Shima
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan.,Thermo-Therapeutics for Vascular Dysfunction, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Masashi Narazaki
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Atsushi Kumanogoh
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
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