{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T16:14:12Z","timestamp":1790007252808,"version":"4.0.1"},"reference-count":35,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,6,9]]},"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:p>TAFRO (thrombocytopenia, anasarca, fever, reticulin myelofibrosis or renal dysfunction and organomegaly) syndrome is a systemic inflammatory disease characterised by thrombocytopenia, anasarca, fever or inflammatory syndrome, reticulin myelofibrosis or renal dysfunction and organomegaly. It was first described as a subtype of idiopathic multicentric Castleman disease. Here, we report the case of a 42-year-old woman presenting with thrombocytopenia, anasarca, inflammatory syndrome, renal insufficiency, reticulin myelofibrosis at bone marrow biopsy and cervical and axillary lymph nodes. Kidney biopsy showed double contours of the glomerular basement membrane, mesangiolysis and endothelial swelling compatible with thrombotic microangiopathy (TMA) as well as with TAFRO syndrome. She was successfully treated by corticosteroids, tocilizumab and rituximab. This new case description of TAFRO syndrome underlines three features of this disease rarely described in the literature and never simultaneously in the same patient: the association to severe hypothyroidism, the presence of TMA-like lesions on kidney biopsy and the treatment by the association of steroids, tocilizumab and rituximab.<\/jats:p>","DOI":"10.1136\/bcr-2019-234155","type":"journal-article","created":{"date-parts":[[2020,6,30]],"date-time":"2020-06-30T15:06:31Z","timestamp":1593529591000},"page":"e234155","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Unexplained cause of thrombocytopenia, fever, anasarca and hypothyroidism: TAFRO syndrome with thrombotic microangiopathy renal histology"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5050-566X","authenticated-orcid":false,"given":"Sylvain Raoul","family":"Simeni Njonnou","sequence":"first","affiliation":[{"name":"Internal Medicine, Hopital Erasme, Brussels, Belgium"},{"name":"Internal Medicine and Specialties, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justine","family":"Deuson","sequence":"additional","affiliation":[{"name":"Heamatology, Hopital Erasme, Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Royer-Chardon","sequence":"additional","affiliation":[{"name":"Pathology, Hopital Erasme, Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1388-9262","authenticated-orcid":false,"given":"Fr\u00e9d\u00e9ric Alain","family":"Vandergheynst","sequence":"additional","affiliation":[{"name":"Internal Medicine, Hopital Erasme, Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginie De","family":"Wilde","sequence":"additional","affiliation":[{"name":"Heamatology, Hopital Erasme, Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,6,30]]},"reference":[{"key":"2025082801063868000_13.6.e234155.1","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1016\/j.path.2019.03.003","article-title":"Castleman disease","volume":"12","author":"Wang","year":"2019","journal-title":"Surg Pathol Clin"},{"key":"2025082801063868000_13.6.e234155.2","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.hoc.2017.09.008","article-title":"Treatment of idiopathic Castleman disease","volume":"32","author":"van Rhee","year":"2018","journal-title":"Hematol Oncol Clin North Am"},{"key":"2025082801063868000_13.6.e234155.3","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-10-746933"},{"key":"2025082801063868000_13.6.e234155.4","first-page":"320","article-title":"[Thrombocytopenia with mild bone marrow fibrosis accompanied by fever, pleural effusion, ascites and hepatosplenomegaly]","volume":"51","author":"Takai","year":"2010","journal-title":"Rinsho Ketsueki"},{"key":"2025082801063868000_13.6.e234155.5","doi-asserted-by":"crossref","unstructured":"Fujimoto S , Sakai T , Kawabata H , et al . Is TAFRO syndrome a subtype of idiopathic multicentric Castleman disease? 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the literature","volume":"12","author":"Islamo\u011flu","year":"2018","journal-title":"Int J Hematol Oncol Stem Cell Res"},{"key":"2025082801063868000_13.6.e234155.11","doi-asserted-by":"crossref","first-page":"149","DOI":"10.3389\/fmed.2017.00149","article-title":"TAFRO syndrome in Caucasians: a case report and review of the literature","volume":"4","author":"Louis","year":"2017","journal-title":"Front Med"},{"key":"2025082801063868000_13.6.e234155.12","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1007\/s00277-017-3138-z","article-title":"A comparison of TAFRO syndrome between Japanese and non-Japanese cases: a case report and literature review","volume":"97","author":"Coutier","year":"2018","journal-title":"Ann Hematol"},{"key":"2025082801063868000_13.6.e234155.13","first-page":"1","article-title":"TAFRO syndrome associated with EBV and successful triple therapy treatment: case report and review of the 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