A case of TAFRO syndrome with refractory ascites and acute renal failure successfully treated with cell-free and concentrated ascites reinfusion therapy (CART) and hemodiafiltration (HDF)

Abstract

A 43-year-old male was admitted because he experienced a sense of fullness in the abdomen for two weeks. Examination revealed high C-reactive protein level, thrombocytopenia, pleural effusion, ascites, and multiple lymphadenopathies. Although the pathological findings of an axillary lymph node biopsy were consistent with those of hyaline-vascular Castleman’s disease, he was diagnosed with TAFRO syndrome based on clinical characteristics 10 days after admission. Treatment with steroids and tocilizumab was initiated, but his ascites worsened and acute prerenal failure progressed because of hypovolemia despite daily use of albumin preparation. Cell-free and concentrated ascites reinfusion therapy (CART) and hemodiafiltration (HDF) was initiated on the 11th and 19th day after admission, respectively. Ascites was controlled with HDF twice a week and ascites filtration and reinfusion with HDF (AFR-HDF) once a week, and the dose of albumin preparation was decreased. The disease displayed gradual remission with the administration of many types of immunosuppressive therapy, and the patient was discharged from the hospital on the 152th day after admission. No effective treatment for TAFRO syndrome has been established. AFR-HDF can be an effective treatment for TAFRO syndrome in case of refractory ascites and acute renal failure.