A Case of Thrombocytopenia, Anasarca, Fever, Reticulin Fibrosis/Renal Dysfunction, and Organomegaly (TAFRO) Syndrome Refractory to Treatment With Combination Therapy of Corticosteroid, Tocilizumab, and Rituximab: A Case Report.

We report a case of TAFRO (thrombocytopenia, anasarca, fever, reticulin fibrosis/renal dysfunction, and organomegaly) syndrome in a previously healthy 76-year-old man who was treated with glucocorticoids, tocilizumab, and rituximab. Despite this combination therapy, he developed multiple infections, and the disease progressed, ultimately leading to death. The patient initially presented with bilateral lower extremity edema and was referred to our hospital for evaluation of severe renal dysfunction and elevated inflammatory markers. Computed tomography revealed mild generalized lymphadenopathy. A bone marrow biopsy showed mild reticulin fibrosis, and a cervical lymph node biopsy demonstrated atrophic germinal centers with prominent interfollicular vascularity, features consistent with Castleman disease-like pathology. Based on these findings, he was diagnosed with TAFRO syndrome. Immunosuppressive treatment was initiated; however, renal dysfunction did not improve, and hemodialysis was initiated three times per week. In addition, infectious complications hindered continuation of therapy. The disease rapidly worsened, and the patient died on day 59 of hospitalization. This case suggests that, in TAFRO syndrome, it is crucial to balance the intensity of immunosuppression with the risk of infectious complications.