Time to redefine HHV-8 MCD and KICS criteria?

Résumé fourni par la source

We read with interest the recently published article by Ramaswami et al., "Characteristics and outcomes of Kaposi sarcoma herpesvirus (KSHV)-associated inflammatory cytokine syndrome (KICS)"(1).This work provides a comprehensive description of a newly recognized KSHV/HHV-8-related entity, and we commend the authors for their valuable contribution to the field.KICS is a heterogeneous entity defined by clinical, biological, and radiological criteria that requires the exclusion of KSHV/HHV-8-associated multicentric Castleman Disease (MCD) (2).KSHV/HHV-8-MCD diagnosis is based on histological findings, including the presence of mixed or plasma cell Castleman changes with KSHV-infected plasmablasts, also known as KSHV-infected viroblasts (KIVs) (3,4).KIVs have also been detected in effusions, where they are called Lambda-restricted plasmablasts (LRPs) (5), and in the peripheral blood mononuclear cells (PBMCs) of patients with MCD flares (reported by our group in the Journal, 6).PBMCs were separated using Ficoll gradient, and a whole blood method is under development.In the study by Ramaswami, patients with detectable KIVs/LRPs in their effusions were removed from the analysis on the basis that they had MCD.We believe this exclusion warrants further discussion.As pointed earlier, MCD diagnosis remains defined by pathological aspects.The diagnostic value of KIV/LRP detection, especially in peripheral blood, has not been fully evaluated in the context of KICS.To explore this, we phenotyped the peripheral blood of seven patients from our French cohort who met KICS criteria.We detected KIVs in 5/7 (71%, Figure 1), indicating that peripheral

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