HIV-associated multicentric Castleman disease with Kaposi sarcoma: A case report with 120-week follow-up of HHV-8 after remission

HIV-associated multicentric Castleman disease (HIV-MCD) is a rare, life-threatening lymphoproliferative disorder featuring systemic inflammation and marked lymphadenopathy. HIV-MCD is characterized by a human herpesvirus-8 (HHV-8) infection, with an increasing incidence despite advances in antiretroviral therapy (ART). Although HHV-8 viremia is a recognized indicator of disease recurrence, the necessity of intervention for low-level viremia reactivation remains unclear. We present a case of a man with HHV-8-associated HIV-MCD and Kaposi sarcoma (KS) who achieved a prolonged remission despite occasional episodes of low-level viremia. A 58-year-old man with untreated HIV infection presented with fever, night sweats, and fatigue. Histopathological analysis confirmed the diagnosis of HIV-MCD with KS. He received rituximab, liposomal doxorubicin, and ART which induced remission. The patient was followed for 120 weeks with serial monitoring of HHV-8 DNA levels. Although occasional viremia was observed, no relapse occurred. When mild HHV-8 reactivation occurred post-therapy without clinical relapse, we avoided unnecessary treatments with potential drug-related toxicities. No established prevention for MCD flares exists, and prolonged rituximab or valganciclovir use risks pulmonary and hematologic toxicity. Thus, HHV-8 DNA monitoring and selective interventions seem practical. Timely diagnosis and immunochemotherapy, including rituximab and liposomal doxorubicin, are critical for the management of HIV-MCD with concurrent KS. This combination mitigated KS progression. Successful management of HIV-MCD requires early recognition and administration of ART and targeted therapies, which can result in sustained remission. Close HHV-8 DNA monitoring and clinical assessment minimize the need for additional treatment, underscoring the importance of balancing efficacy and safety in individualized HIV-MCD management.