Recovery trajectories of TAFRO syndrome: a single-center case series highlighting prolonged thrombocytopenia and anasarca

TAFRO syndrome is a rare systemic inflammatory disorder characterized by thrombocytopenia, anasarca, fever or inflammation, reticulin fibrosis or renal dysfunction, and organomegaly. Despite increasing recognition, its natural history, particularly the timeline of organ-specific recovery, remains poorly understood. We retrospectively analyzed seven patients, encompassing nine treatment courses, diagnosed with TAFRO syndrome at our institution. Time to recovery was assessed across four clinical domains-renal dysfunction, systemic inflammation, anasarca, and thrombocytopenia-using predefined objective criteria. The median time to recovery was 7.0 days for renal dysfunction, 21.0 days for systemic inflammation, 24.0 days for anasarca, and 46.0 days for thrombocytopenia. Recovery of thrombocytopenia and anasarca tended to be delayed compared with that of renal dysfunction and systemic inflammation, with thrombocytopenia showing the longest median time to recovery. These findings indicate substantial heterogeneity in organ-specific recovery trajectories in TAFRO syndrome, with hematologic and fluid-related manifestations resolving more slowly than inflammatory or renal abnormalities. Recognition of domain-specific recovery timelines may aid interpretation of treatment responses and support more balanced, individualized management strategies.