Multicentric Castleman's disease in Malawi

摘要

A 51-year-old man was referred to our hospital in Lilongwe with 6 months of diffuse progressive lymphadenopathy and hepatosplenomegaly with fever, chills, night sweats, and weight loss. He had been on antiretroviral therapy for HIV for 5 years, and his CD4 cell count was 234 cells per uL and HIV RNA was 357 copies per mL Fine needle aspiration of a lymph node suggested Hodgkin's lymphoma. Immunohistochemistry reagents were temporarily out of stock, as sometimes happens in Malawi. We started chemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine while waiting for results of a confirmatory biopsy sample. Lymphoma is often diagnosed by fine needle aspiration in sub-Saharan African settings,1 and we often have to start treatment on the basis of less complete diagnostic information than is available in resource-rich settings.