Development of severe thrombocytopenia with TAFRO syndrome-like features in a patient with rheumatoid arthritis treated with a Janus kinase inhibitor: A case report.

RATIONALE: Thrombocytepenia, anasarca, fever, renal insufficiency, and organomegaly (TAFRO) syndrome is a novel disease entity characterized by a constellation of symptoms (thrombocytopenia, anasarca, fever, renal insufficiency, and organomegaly). Here, we describe the development of TAFRO syndrome-like features during the treatment of rheumatoid arthritis with a Janus kinase (JAK) inhibitor. PATIENT CONCERNS: In this report, a 74-year-old woman treated with a JAK inhibitor (tofacitinib) for rheumatoid arthritis was admitted because of fever and thrombocytopenia. DIAGNOSES: On laboratory examination, marked thrombocytopenia and elevated creatinine and C-reactive protein levels were present. A computed tomography scan revealed lymphadenopathy, hepato-splenomegaly, and anasarca. A left axillary lymph node biopsy revealed Castleman's disease-like features. These clinical features satisfied the proposed diagnostic criteria for TAFRO syndrome. Since autoimmune disorders should be excluded when diagnosing TAFRO syndrome, it is not strictly correct to diagnose her as TAFRO syndrome. Therefore, we diagnosed her as rheumatoid arthritis complicated by TAFRO syndrome-like features. INTERVENTIONS: The patient was treated with high-dose glucocorticoid, tacrolimus, eltrombopag, intravenous immunoglobulin, and rituximab. OUTCOMES: Her condition was refractory to the above-mentioned treatment, and she eventually died because of multi-organ failure 6 months after the first admission. LESSONS: TAFRO syndrome-like features can develop during treatment with a JAK inhibitor for rheumatoid arthritis. Patients with autoimmune diseases complicated by TAFRO syndrome-like features can follow a fatal clinical course, and thus, an intensive combined treatment is warranted for such patients, especially in cases refractory to glucocorticoid.

Hiperplasia folicular linfoide subcutánea secundaria a vacunas: descripción de los hallazgos ecográficos y correlación clínico-patológica / Subcutaneous lymphoid follicular hyperplasia secondary to vaccination: correlation of ultrasound findings with clinical and histological findings

En los últimos años, el uso de vacunas se encuentra estandarizado dentro de los programas de vacunación. Los efectos adversos en el sitio de punción suelen ser leves y transitorios. Sin embargo, en algunos casos se pueden desarrollar nódulos subcutáneos persistentes, los cuales son a menudo infradiagnosticados debido a su rareza y al largo periodo de tiempo que puede transcurrir entre la vacunación y su aparición. Histológicamente, consisten en una hiperplasia folicular linfoide reactiva a partículas de aluminio usadas normalmente como adyuvante en algunas vacunas. No hemos encontrado bibliografía radiológica que haga referencia a estos nódulos de partes blandas secundarios a vacunas. Describimos los hallazgos ecográficos característicos de estas lesiones, que permitirán al radiólogo su reconocimiento y elaborar un diagnóstico de alta sospecha, evitando la realización de pruebas de imagen innecesarias que podrían llevar a confusión y por tanto a un manejo inadecuado de estos pacientes (AU)

In recent years, the use of vaccines has been standardized within vaccination programs. Adverse effects at the puncture site are usually mild and transient. Nevertheless, in some cases, persistence subcutaneous nodules can develop; these are often underdiagnosed because they are so rare and because of the long time that can transpire between the vaccination and their appearance. Histologically, they consist of a lymphoid follicular hyperplasia that occurs as a reaction to the aluminum particles usually used as an adjuvant in some vaccines. We were unable to find any reference in the radiological literature to these soft-tissue nodules secondary to vaccination. We report the characteristic ultrasound findings that will enable radiologists to identify or strongly suspect these lesions and thereby avoid unnecessary imaging tests that might lead to confusion and inadequate management of these patients (AU)

Angiofollicular lymphoid hyperplasia (Castleman's disease) in two mice treated with polyoma virus or urethane.

Localized angiofollicular hyperplasia, otherwise known as Castleman's disease, is described in the lymph nodes of 2 mice of different strains, one inoculated with polyoma virus at birth and the other given urethane within 24 hr of birth. A plasma cell component in the lesion, suggestive of bone marrow stem cell involvement, was present in the mouse treated with polyoma virus but absent in the mouse given intraperitoneal urethane. Dysregulated interleukin 6 has recently been reported to produce the systemic variety of angiofollicular hyperplasia in mice, but the role of this cytokine in the localized variety described in this report is not known. This lesion appears to be rare in mice, but when present it could easily be missed or overlooked because the typical layering of follicle cells and the relatively large germinal centers seen in humans do not appear prominent in mice. Although there is, obviously, no proof of a causal relationship between the lesion and polyoma virus or urethane, it is suggested that this lesion be searched for in order to estimate its frequency and possible etiologic associations.