Relapse of HIV-associated multicentric Castleman disease temporally associated with acute coronavirus disease 2019: a case report.

backgroundHuman immunodeficiency virus-associated multicentric Castleman disease (HIV-MCD), a human herpesvirus 8 (HHV-8)-driven lymphoproliferative disorder affecting individuals infected by HIV, typically exhibits a relapsing-remitting course and can be fatal. The incidence of HIV-MCD is on the rise while that of Kaposi's sarcoma, another HHV-8-associated disease, has been declining. Although an increasing number of studies have reported relapses of human herpesvirus-associated diseases and HIV-negative MCD following coronavirus disease 2019 (COVID-19), to the best of our knowledge there are no reports of HIV-MCD relapses. CASE PRESENTATION: A 75-year-old male patient with well-controlled HIV infection and pre-existing HIV-MCD experienced a relapse of HIV-MCD temporally associated with infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). He had a two-month history of persistent cough and received the diagnosis of mild COVID-19 based on positivity for SARS-CoV-2 on a polymerase chain reaction test and characteristic findings on computed tomography. Although the COVID-19 resolved with remdesivir therapy, the patient subsequently experienced a fever, generalized lymphadenopathy, splenomegaly, and thrombocytopenia. A lymph node biopsy confirmed a MCD relapse. The patient improved markedly after rituximab therapy.

conclusionThis case is the first to report a temporal association between SARS-CoV-2 infection and HIV-MCD relapse. While a direct causal relationship cannot be established, the clinical course is consistent with the hypothesis that SARS-CoV-2 infection may have contributed to HHV-8 reactivation and MCD relapse. Further case series and mechanistic studies are needed to evaluate this potential association.