Liver cirrhosis in a child associated with Castleman's disease: A case report

Table 1 Laboratory findings on admission

Blood cell count
WBC	8.49 × 103/μL
NET%	76.1%
LYP%	19.8%
MONO%	2.7%
EOS%	1.3%
RBC	423 × 104/μL
Hb	9.5 g/dL
Ht	31.2%
MCV	73.8 fL
MCH	22.5 pg
MCHC	30.4%
PLT	17 × 104/μL
Biochemical and immune serum examination
TP	8 g/dL
Alb	3.1 g/dL
T-bil	1 mg/dL
D-bil	0.6 mg/dL
AST	95 U/L
ALT	63 U/L
LDH	289 U/L
γ-GTP	132 U/L
ALP	3152 U/L
Glu	97 mg/dL
BUN	7.5 mg/dL
Cr	0.39 mg/dL
CRP	6.83 mg/dL
Fe	24 μg/dL
TIBC	299 μg/dL
UIBC	286 μg/dL
Ferritin	65.9 ng/mL
NH3	36 μg/dL
AFP	1.3 ng/mL
IgG	2265 mg/dL
IgG4	191 mg/dL
IgA	469 mg/dL
IgM	399 mg/dL
Blood coagulation examination
PT ratio	60.5%
APTT	32.2 s
Fib	328 mg/dL
FDP	6.6 μg/mL
D-dimer	2.8 μg/mL
Cytokine/VEGF
IL-6	40 pg/mL
VEGF	49.2 pg/mL
Virologic test
HIV antibody	(-)
HHV-8 PCR	(-)

WBC: White blood cell; RBC: Red blood cell; Hb: Hemoglobin; MCV: Mean corpuscular volume; MCH: Mean corpuscular hemoglobin; MCHC: Mean corpuscular hemoglobin concentration; PLT: Blood platelet; CRP: C-reactive protein; TP: Total protein; ALP: Albumin; Glu: Glucose; BUN: Blood urea nitrogen; TIBC: Total iron binding capacity; UIBC: Unsaturated iron binding capacity; AFP: Alpha fetoprotein; VEGF: Vascular endothelial growth factor; HIV: Human immunodeficiency virus; PCR: Polymerase chain reaction.

Table 2 Patients with multicentric Castleman’s disease/TAFRO syndrome complicated by hepatobiliary diseases

Year	Age/sex	Diagnosis	Type	Pathological findings of the liver	Outcome	Ref.
1991	22/F	CD	Mixed	Liver cirrhosis associated with Budd-Chiari syndrome, an underlying disease	Liver transplantation waiting for Budd-Chiari syndrome	[14]
1995	50/M	CD	PC	Diffuse fibrosis	Death due to thrombocytopenia and massive gastrointestinal bleeding	[15]
	35/M	CD	PC	Cholestasis and peliosis hepatis	Unknown
2003	54/M	CD	Mixed	Nodular cirrhosis	Perform liver transplantation and maintain remission	[16]
2005	45/M	CD	PC	Nodular regenerative hyperplasia	PSL effective	[17]
2013	51/M	CD	-	Liver amyloidosis	Symptoms persist even after lymph node dissection	[18]
2016	56/M	TAFRO	Mixed	Expansion of portal area, interface hepatitis, pseudo biliary hyperplasia and cholangitis	Steroid pulse, PSL, tocilizumab, rituximab	[19]
2017	26/F	CD	PC	Fibrosis and plasma cell infiltration	PSL effective	[20]
This case	10/M	CD or TAFRO	Mixed	Portal vein area fibrosis, inflammatory cell infiltration, bile duct hyperplasia	PSL ineffective, tocilizumab improves inflammatory response

CD: Castleman's disease; PC: Plasma cell; PSL: Prednisolone.