TAFRO Syndrome - A Specific Subtype of Castleman＇s Disease in China

To the Editor： Castleman＇s disease （CD） describes a group of lymphoproliferative disorders with heterogeneous clinical manifestations.[1] CD comprises at least two distinct diseases （unicentric CD [UCD] and multicentric CD [MCD]） with respective clinical features and prognoses： UCD often involves one lymph node area with favorable outcome： MCD is a systemic disease with relatively poor prognosis which involves multiple lymph node areas with constitutional symptoms （e.g. fever, night sweats, and weakness） and organ dysfunction. According to pathogenesis, MCD can be further divided into different subtypes based on the status of human herpes virus-8 （HHV-8） infection. Of the HHV-8 negative MCD （also named as idiopathic MCD [iMCD]）, there is a peculiar subtype named TAFRO syndrome which constitutes a constellation of unique clinical manifestations （T： Thrombocytopenia, A： Anasarca, F： myelofibrosis, R： Renal dysfunction, and O： Organomegaly）. This syndrome, first reported in Japan[2] has been reported mostly in the Japanese population and occasionally in Caucasians. There is no such case reported in China. We herein report the first patient with TAFRO syndrome in China with confirmed myelofibrosis.

Primary Adrenal Insufficiency Due to Bilateral Adrenal Hematomas in a Patient with Primary Antiphospholipid Syndrome

To the Editor： In 2016, a 35-year-old Chinese man was admitted to our hospital who had experienced multiple thromboses for 9 years, severe fatigue, and oliguria for a total of 3 weeks. The patient had been diagnosed with pulmonary embolism and multiple deep vein thromboses at a local hospital 9 years ago. The patient was prescribed warfarin, and the international normalized ratio （INR） was maintained between 2.42 and 3.18. While laboratory findings revealed a prolonged case （77.8 s） of activated partial thromboplastin time （APTT） at that time, no further investigations were carried out and anticoagulation therapy for the patient was terminated alter 3 months.

Cholangiocarcinoma presenting with acquired thrombotic thrombocytopenic purpura confirmed by positive autoantibodies of a disintegrin and metalloproteinase with a thrombospondin type 1 motif,member 13

To the Editor:Thrombotic thrombocytopenic purpura(TTP)is a type of life-threatening thrombotic microangiopathy(TMA)clinically characterized by severe thrombocytopenia,microangiopathic hemolytic anemia,and symptoms of regional ischemia/infarction including neurologic dysfunction and renal insufficiency.