TAFRO (thrombocytopenia, anasarca, fever, renal insufficiency or reticulin fibrosis, and organomegaly) syndromeis a recently recognized disease with a variety of presentation of variable severity. In acute settings, this disease also involves organ dysfunction because of the associated systemic inflammation. However, cases of TAFRO syndrome with myocardial and/or skeletal muscle calcification have never been reported.
A 24-year-old healthy young man was admitted with intermittent epigastric pain and fever for two weeks. Computed tomography revealed pleural effusion, ascites and systemic lymphadenopathy. Laboratory tests showed thrombocytopenia, elevated C-reactive protein, hypoalbuminemia, anemia and renal dysfunction. Based on these findings and bone marrow biopsy, we diagnosed his disease as TAFRO syndrome and commenced hemodialysis for the renal dysfunction.However, he developed refractory hypocalcemia with unstable vital signs, for which we administered calcium gluconate hydrate. Thereafter, myocardial and skeletal musclecalcification was revealed radiologically, with the myocardial calcification causing sick sinus syndrome. He was treated with tocilizumab and finally discharged in an ambulatory condition after prolonged hospitalization with residual lesions of calcification.
This is the first TAFRO syndromereport with the complication of organ calcification. The etiology of calcification in this case is not clear.Systemic inflammation with possible hypercytokinemia might have been involved in the unexpected complication of systemic calcification.It is important to handle general management of TAFRO syndrome carefully because of various complications.