Burn center admissions of patients with autoimmune rheumatic diseases: clinical characteristics and outcomes.

The ojective of this study was to describe the reasons for admission to the burn center of patients with autoimmune rheumatic diseases (ARD), identify their clinical characteristics, and assess their outcomes relative to the non-ARD patients. We conducted a retrospective study of ARD patients admitted to a burn center from 2011 to 2018, and they were compared with a non-ARD group of patients. Medical records were reviewed for patients' clinical characteristics, including demographics, ARD diagnosis, laboratory studies, and APACHE II score. Additionally, we evaluate the reason for admission in the burn center, management during the burn center stay, complications, outcomes including length of stay, and mortality during the hospital stay. Among the 1094 adult patients admitted during the study period, 30 (2.7%) had a new or prior diagnosis of ARD. The most common ARD associated with admission in the burn center was rheumatoid arthritis (RA) (37%, n = 11) followed by systemic lupus erythematosus (SLE) (33%, n = 10). Burn injuries (47%, n = 14), and Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) (30%, n = 9) were the most frequent admission reasons. Compared with the non-ARD group (n = 52), ARD patients were more likely to be females (60% vs. 24%, P = 0.004), to receive glucocorticoids (50% vs. 6.9%; P < 0.05), require renal replacement (20% vs. 5%, P < 0.05) and enteral nutrition (63% vs. 24%; P < 0.05) during their burn stay. The non-ARD group was more likely to be admitted for burn injuries (81% vs 46%, P < 0.01). RA and SLE were the most common ARD, and burn injuries, followed by SJS/TEN, the most frequent causes associated with burn admissions. ARD patients were more likely to be female, received glucocorticoids, require renal replacement, and enteral nutrition during the burn stay.

The Potential Clinical Benefit of Tocilizumab Therapy for Patients with HHV-8-infected AIDS-related Multicentric Castleman Disease: A Case Report and Literature Review.

Castleman disease (CD), also known as angiofollicular hyperplasia, is a rare disorder characterized by nonmalignant mediastinal lymph node enlargement provoked by excess interleukin-6 (IL-6) secretion. It could be unicentric or multicentric (MCD). Here, we describe a 27-year-old man with a prior history of AIDS, Kaposi sarcoma (KS), and latent syphilis who presented to the ED for persistent fatigue, fever, chills, night sweats, and productive cough. Infectious workup was negative, and the patient continued to have a high fever despite empiric antibiotic therapy. Bone marrow biopsy was performed and was negative for malignancy. The patient eventually underwent a left clavicular lymph node biopsy, which showed a plasma cell variant CD with positive immunostaining for human herpesvirus 8 (HHV-8), and high HHV-8 viral load. We started the patient on rituximab and liposomal doxorubicin, but unfortunately, the patient had a severe anaphylactic reaction to the rituximab, so we could not proceed with this treatment. We, therefore, started tocilizumab treatment, which improved the patient's general condition, and he was eventually discharged from our hospital. Upon follow-up 11-months later, a repeat CT scan of the chest and abdomen showed a near-complete treatment response with decreased lymphadenopathy throughout and hepatosplenomegaly. IL-6 overproduction in patients with CD is linked to the production of inflammatory cytokines and has a role in tumor angiogenesis, which makes it potential for IL-6 targeted therapy. The diagnosis of CD, especially MCD, requires a high index of suspicion, and a lymph node biopsy is essential in the diagnosis. Tocilizumab, an IL-6 receptor antibody, could potentially be considered as a practical therapeutic approach in managing HHV-8 positive MCD patients who do not tolerate or respond to initial rituximab therapy.