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Two weeks before admission, he developed right-sided pleuritic chest pain. Chest CT revealed bilateral pleural effusions and generalised lymphadenopathy involving the lower cervical, mediastinal and axillary regions. An excisional biopsy of a right lower cervical lymph node demonstrated hyaline-vascular architecture, including \u2018lollipop\u2019 lesions and onion-skinning of the mantle zones. Immunohistochemistry showed human herpesvirus 8 (HHV-8)-positive plasmacytoid cells within the mantle zones, without malignant features, consistent with HHV-8-associated multicentric Castleman disease (MCD). The patient continued antiretroviral therapy and received rituximab 375 mg\/m\u00b2 every week for four cycles. He achieved complete resolution of the pleural effusions. This case illustrates the variable clinical presentation of HHV-8-associated MCD in a patient living with HIV.<\/jats:p>","DOI":"10.1136\/bcr-2026-274654","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T11:55:20Z","timestamp":1785930920000},"page":"e274654","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic challenge of human herpesvirus 8-associated multicentric Castleman disease in a patient living with HIV disease"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-2347-8064","authenticated-orcid":false,"given":"Sasiwan","family":"Atithammarak","sequence":"first","affiliation":[{"name":"Division of Infectious Disease, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gompol","family":"Suwanpimolkul","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"2026080504551172000_19.8.e274654.1","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1182\/blood.2019000931","article-title":"Overview of Castleman disease","volume":"135","author":"Dispenzieri","year":"2020","journal-title":"Blood"},{"key":"2026080504551172000_19.8.e274654.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hoc.2017.09.004"},{"key":"2026080504551172000_19.8.e274654.3","doi-asserted-by":"crossref","first-page":"4924","DOI":"10.1182\/bloodadvances.2024013548","article-title":"The clinical picture of Castleman disease: a systematic review and meta-analysis","volume":"8","author":"Hoffmann","year":"2024","journal-title":"Blood Adv"},{"key":"2026080504551172000_19.8.e274654.4","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.15019"},{"key":"2026080504551172000_19.8.e274654.5","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2011-02-333633"},{"key":"2026080504551172000_19.8.e274654.6","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e3182a8338f"},{"key":"2026080504551172000_19.8.e274654.7","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2014-07-586800"},{"key":"2026080504551172000_19.8.e274654.8","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V99.7.2331"},{"key":"2026080504551172000_19.8.e274654.9","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000028077","article-title":"Human herpesvirus 8-associated multicentric Castleman disease in a patient with advanced HIV infection: A case report","volume":"100","author":"Guayboon","year":"2021","journal-title":"Medicine (Baltimore)"},{"key":"2026080504551172000_19.8.e274654.10","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.15.3.439-464.2002"},{"key":"2026080504551172000_19.8.e274654.11","doi-asserted-by":"publisher","DOI":"10.1038\/nrclinonc.2010.103"},{"key":"2026080504551172000_19.8.e274654.12","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-024-84376-2","article-title":"In silico analysis of human herpes virus-8 genome: a comparison of the K1, VR1, and VR2 regions for genotyping and global geographical distribution","volume":"15","author":"Khodadad","year":"2025","journal-title":"Sci Rep"},{"key":"2026080504551172000_19.8.e274654.13","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0609.2003.00018.x"},{"key":"2026080504551172000_19.8.e274654.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2016.05.005"},{"key":"2026080504551172000_19.8.e274654.15","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2010.34.1909"},{"key":"2026080504551172000_19.8.e274654.16","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.10.6732"},{"key":"2026080504551172000_19.8.e274654.17","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-10-747477"},{"key":"2026080504551172000_19.8.e274654.18","doi-asserted-by":"crossref","first-page":"106366","DOI":"10.1016\/j.jinf.2024.106366","article-title":"Clinical management of human herpesvirus-8-related illnesses in solid organ transplant recipients","volume":"90","author":"Dalla Pria","year":"2025","journal-title":"J Infect"},{"key":"2026080504551172000_19.8.e274654.19","doi-asserted-by":"crossref","first-page":"83","DOI":"10.4103\/jfcm.JFCM_106_18","article-title":"Review of literature on disseminated tuberculosis with emphasis on the focused diagnostic workup","volume":"26","author":"Khan","year":"2019","journal-title":"J Family Community Med"},{"key":"2026080504551172000_19.8.e274654.20","unstructured":"World Health Organization . 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