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

Sep 28, 2026

Multicentric Castleman disease is a rare lymphoid tissue proliferative disorder, with limited reports in Asian populations, especially among HIV-positive patients. This case report describes a 44-year-old male with HIV infection who developed recurrent fever and bilateral axillary masses, requiring seven years for definitive diagnosis. Blood metagenomic next-generation sequencing detected KSHV and EBV. Treatment with rituximab, thalidomide, sodium phosphonates, and ganciclovir produced complete symptom resolution and normalized indicators, with no recurrence during follow-up.

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Introduction

Case Presentation

Wiley Case Reports in Infectious Diseases Volume 2026, Article ID 5567369, 9 pages [https://doi.org/10.1155/crdi/5567369](https://doi.org/10.1155/crdi/5567369) Case Report EBV+ and Kaposi’s Sarcoma Herpesvirus-Associated Multicentric Castleman Disease in a Patient With HIV Infection: A Case Report Mai-Yin Huang , 1 Zhe Li , 1 Wei Zhang ,2 Hai-Yun Chen ,2 Jun Liu ,2 and Chong-Xi Li 2 1 Department of Dermatology, First Afliated Hospital of Kunming Medical University, Kunming, Yunnan, China 2 Department of Infectious Disease, Te Tird People’s Hospital of Kunming (Yunnan Clinical Medical Center for Infectious Diseases), Kunming, Yunnan, China Correspondence should be addressed to Jun Liu; liujun6408100@163.com and Chong-Xi Li; [lichongxi520@163.com](lichongxi520@163.com)[ ](lichongxi520@163.com)Received 6 November 2024; Revised 5 October 2025; Accepted 24 November 2025 Academic Editor: Priya Gusain Copyright © 2026 Mai-Yin Huang et al. Case Reports in Infectious Diseases published by John Wiley & Sons Ltd. Tis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. 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 defnitive 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) . Te patient was administered rituximab, thalidomide, sodium phosphonates, and ganciclovir. Te patient’s symptoms were completely relieved, and all indicators returned to normal, with no recurrence during follow-up. Tis case underlines that it is necessary to perform multiple lymph node biopsies or repeat the biopsies multiple times for the diagnosis of KSHV-MCD. Keywords: case report; Epstein-Barr virus; human immunodefciency virus; Kaposi’s sarcoma herpesvirus; Multicentric Castleman disease; rituximab 1. Introduction Castleman disease (CD) is a rare lymphoproliferative disorder that was frst reported by Castleman et [al. in](al. in) 1956 [1]. It is classifed into unicentric Castleman disease (UCD) and Multicentric Castleman disease (MCD) based on clinical presentation and course. MCD presents with systemic, progressive, and life-threatening symptoms, including recurrent systemic symptoms (weight loss, fever, and fatigue), hepatosplenomegaly, anemia, fatigue, multiple regional lymphadenopathies, and poorer prognosis than UCD [2, 3] . Although the precise etiology and pathogenesis remain elusive, previous studies have implicated Kaposi’s sarcoma herpesvirus (KSHV) infection as pivotal in its pathogenesis. KSHV encodes its viral cytokines, such as viral IL-6 (vIL-6), which is similar to human IL-6, and they are implicated in lymph node hyperplasia and infammation [4–6] . In 2014, Fajgenbaum et al. proposed further classifying MCD based on KSHV status into KSHVassociated MCD (KSHV-MCD) and KSHV-negative MCD (iMCD) [7] . In a recent study, OS at 5 and 10 years for patients with KSHV-MCD (without Kaposi sarcoma [KS]) was 90% and 73% . For those with both KSHV-MCD and KS, OS at 10 years was 81%[4] . KSHV-MCD tends to occur in HIV-infected patients or immunosuppressed individuals. Little epidemiological data are available on CD, particularly in low- and middle-income countries [8] . In Western countries, MCD cases are thought to be divided almost evenly between KSHV-MCD and iMCD [9] . Conversel

FAQs

What condition is described in the case report?

The report describes Kaposi’s sarcoma herpesvirus-associated multicentric Castleman disease (KSHV-MCD) in a patient with HIV infection.

How were KSHV and EBV identified in the patient?

Metagenomic next-generation sequencing of blood showed infection with KSHV and EBV, supported by positive EBV antibody testing.

What treatment led to symptom resolution and what was the outcome?

The patient received rituximab, thalidomide, sodium phosphonates, and ganciclovir, which completely relieved symptoms and normalized indicators, with no recurrence during follow-up.

Sep 28, 2026

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