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PMID- 28353560
DA  - 20170329
DCOM- 20170406
LR  - 20170413
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 13
DP  - 2017 Mar
TI  - A life-threatening case of TAFRO syndrome with dramatic response to tocilizumab, 
      rituximab, and pulse steroids: The first case report in Latin America.
PG  - e6271
LID - 10.1097/MD.0000000000006271 [doi]
AB  - RATIONALE: This is the report of the first case of TAFRO syndrome
      (Thrombocytopenia, Anasarca, myelofibrosis, Renal dysfunction, Organomegaly) in
      Latin America. PATIENT CONCERNS: The patient was a 61-year-old white woman of
      Ashkenazi Jewish descent, who presented with a history of 8 days of nausea,
      vomiting, and fever; severe pitting edema in both legs, ascites, splenomegaly,
      and palpable axillary lymph nodes. DIAGNOSES: Abdominal computed tomography (CT) 
      showed bilateral pleural effusion and retroperitoneal lymph node enlargement.
      INTERVENTIONS: Anasarca and worsening of renal function led to admission to the
      intensive care unit (ICU) with multiple organ failure, requiring mechanical
      ventilation, vasopressor medications, and continuous renal replacement therapy
      (CRRT). Diagnosis of TAFRO syndrome was made on day 18 after admission, based on 
      clinical findings and results of bone marrow and lymph node biopsies. She was
      treated with methylprednisolone, tocilizumab, and rituximab. One week after the
      first tocilizumab dose, she had dramatic improvements in respiratory and
      hemodynamic status, and was weaned from ventilator support and vasopressor
      medications. OUTCOMES: After 2 weeks of therapy, CRRT was switched to
      intermittent hemodialysis. On day 46, the patient was discharged from the ICU to 
      the general ward, and 3 months after admission, she went home. LESSONS: Provided 
      the interleukin-6 measurement is available, this approach is suggested in cases
      of TAFRO syndrome, in order to customize the treatment.
FAU - Jose, Fabio Freire
AU  - Jose FF
AD  - aDepartment of Rheumatology bDepartment of Hematology cDepartment of Pathology,
      Hospital Israelita Albert Einstein dDepartment of Pathology, Faculdade de
      Medicina da Universidade de Sao Paulo eDepartment of Nuclear Medicine fDepartment
      of Internal Medicine gDepartment of Hematology, Hospital Israelita Albert
      Einstein, Sao Paulo, SP, Brazil.
FAU - Kerbauy, Lucila Nassif
AU  - Kerbauy LN
FAU - Perini, Guilherme Fleury
AU  - Perini GF
FAU - Blumenschein, Danielle Isadora
AU  - Blumenschein DI
FAU - Pasqualin, Denise da Cunha
AU  - Pasqualin DD
FAU - Malheiros, Denise Maria Avancini Costa
AU  - Malheiros DM
FAU - Campos Neto, Guilherme de Carvalho
AU  - Campos Neto GC
FAU - de Souza Santos, Fabio Pires
AU  - de Souza Santos FP
FAU - Piovesan, Ronaldo
AU  - Piovesan R
FAU - Hamerschlak, Nelson
AU  - Hamerschlak N
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Anti-Inflammatory Agents)
RN  - 0 (Antibodies, Monoclonal, Humanized)
RN  - 0 (Immunologic Factors)
RN  - 4F4X42SYQ6 (Rituximab)
RN  - I031V2H011 (tocilizumab)
RN  - X4W7ZR7023 (Methylprednisolone)
RN  - Multi-centric Castleman's Disease
SB  - IM
MH  - Anti-Inflammatory Agents/*administration & dosage
MH  - Antibodies, Monoclonal, Humanized/*administration & dosage
MH  - Drug Therapy, Combination
MH  - Female
MH  - Giant Lymph Node Hyperplasia/*drug therapy
MH  - Humans
MH  - Immunologic Factors/*administration & dosage
MH  - Methylprednisolone/*administration & dosage
MH  - Middle Aged
MH  - Rituximab/*administration & dosage
PMC - PMC5380244
EDAT- 2017/03/30 06:00
MHDA- 2017/04/07 06:00
CRDT- 2017/03/30 06:00
AID - 10.1097/MD.0000000000006271 [doi]
AID - 00005792-201703310-00006 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Mar;96(13):e6271. doi: 10.1097/MD.0000000000006271.

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