systemic edema with bilateral pleural effusion were emerged, suspecting TAFRO syndrome.Results: Methylprednisolone pulse therapy (1 g/day for 3 days) was given, but there was no response.Tocilizumab (8 mg/kg) was initiated right after predonisolene.The patient became anuric and required hemodialysis.Following combined immunosuppressive therapy, inflammatory markers, renal function, and platelet count gradually improved.Serum IL-6 and VEGF were both elevated (124 pg/mL, 3743 pg/mL, respectively).Renal biopsy were not performed given the unilateral enlargement and her systemic condition.Bone marrow biopsy and flowcytometry showed fibrotic changes with increased megakaryocyte, confirming TAFRO syndrome. Conclusion:We report a case of TAFRO syndrome initially misdiagnosed as pyelonephritis.Prompt induction of Combined prednisolone and tocilizumab therapy led to a favorable outcome, underscoring the importance of early recognition and aggressive immunosuppressive intervention in this potentially life-threatening condition.I have no potential conflict of interest to disclose.I did not use generative AI and AI-assisted technologies in the writing process.
Chigusa et al. (Wed,) studied this question.