# EBV+ and Kaposi’s Sarcoma Herpesvirus‐Associated Multicentric Castleman Disease in a Patient With HIV Infection: A Case Report

## TL;DR

A 44-year-old HIV patient with a rare lymphoid disease showed improvement after treatment, highlighting the need for repeated biopsies for accurate diagnosis.

## Contribution

This case report highlights the importance of repeated biopsies in diagnosing KSHV-associated multicentric Castleman disease in HIV patients.

## Key findings

- The patient was diagnosed with KSHV-associated multicentric Castleman disease after a 7-year delay.
- Metagenomic sequencing confirmed KSHV and EBV infections in the patient.
- Symptoms resolved completely after treatment with rituximab, thalidomide, and antiviral drugs.

## Abstract

Multicentric Castleman disease is a rare proliferative disease of lymphoid tissue. It has rarely been reported in Asian countries, particularly in HIV‐positive patients. Here, we report a case of Kaposi’s sarcoma herpesvirus‐associated Multicentric Castleman disease (KSHV‐MCD). A 44‐year‐old male HIV patient with a good response to antiretroviral therapy presented with recurrent fever and bilateral axillary masses. He was hospitalized for recurrent exacerbations, and it took 7 years from onset to definitive diagnosis. Lymph node biopsy suggested Castleman disease. Metagenomic next‐generation sequencing (mNGS) of the blood showed that the patient was infected with KSHV (8327 sequence reads) and EBV (283 sequence reads). The patient was administered rituximab, thalidomide, sodium phosphonates, and ganciclovir. The patient’s symptoms were completely relieved, and all indicators returned to normal, with no recurrence during follow‐up. This case underlines that it is necessary to perform multiple lymph node biopsies or repeat the biopsies multiple times for the diagnosis of KSHV‐MCD.