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Pulmonary manifestations of multicentric Castleman's disease in HIV infection: a clinical, biological and radiological study

¹ Service de Pneumologie, ⁵ Radiologie, and ⁶ Médecine Interne, Hôpital Foch, Suresnes, and ³ Service de Microbiologie, and ⁴ Immunologie-Hématologie Clinique, Hôpital Saint-Louis, and ² Service des Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpétrière, Paris, France.

CORRESPONDENCE: A. Guihot, Service de Pneumologie, Hôpital Foch, 40, rue Worth, 92151 Suresnes Cedex, France. Fax: 33 146252898. E-mail: amelie_guihot@yahoo.fr

Keywords: Acute respiratory distress syndrome, HIV, human herpesvirus-8, interstitial pneumonitis, multicentric Castleman's disease, non-Hodgkin's lymphoma

Received: November 14, 2004
Accepted March 8, 2005

The aim of the present study was to report clinical, radiological and bronchoalveolar lavage (BAL) findings in patients with pulmonary manifestations of HIV-associated multicentric Castleman's disease (MCD).

This was a retrospective study of 12 patients with histologically proven MCD.

Clinical manifestations were as follows: dyspnoea (nine out of 12 cases), cough (n = 10), bilateral crackles (n = 10), together with high fever, malaise, peripheral lymphadenopathy (n = 12), and hepatosplenomegaly (n = 10). Two patients developed acute respiratory distress syndrome. Chest radiographs and computed tomography scans showed reticular (n = 7) and/or nodular (n = 7) interstitial patterns, with mediastinal lymphadenopathy (n = 9), and bilateral pleural effusion (n = 3). Fibreoptic endoscopy was normal in all cases. BAL analysis showed hypercellularity (n = 6) and/or lymphocytosis (n = 6), and human herpesvirus-8 DNA was detected in two out of two cases. Specific stains and cultures for pathogens were negative. All patients received etoposide and/or vinblastine, and improved after 2–4 days. Relapses were frequent (50 attacks in 12 patients). Six patients developed a non-Hodgkin's lymphoma, and five died.

In conclusion, the pulmonary manifestation of HIV-related multicentric Castleman's disease is an acute reticulo-nodular interstitial pneumonitis, associated with severe systemic symptoms and peripheral lymphadenopathy. In bronchoalveolar lavage fluid, cellularity is not specific and human herpesvirus-8 DNA is detected. The clinical course is specific due to a rapid onset and regression, frequent relapses and a high occurrence of non-Hodgkin's lymphoma.

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				A. Guihot, E. Oksenhendler, L. Galicier, A.-G. Marcelin, L. Papagno, A.-S. Bedin, F. Agbalika, N. Dupin, J. Cadranel, B. Autran, et al. Multicentric Castleman disease is associated with polyfunctional effector memory HHV-8-specific CD8+ T cells Blood, February 1, 2008; 111(3): 1387 - 1395. [Abstract] [Full Text] [PDF]