Survival and Hospital Discharge Achieved Through Intensive Circulatory, Fluid, and Respiratory Support in Severe TAFRO (Thrombocytopenia, Anasarca, Fever, Reticulin Fibrosis, and Organomegaly) Syndrome With Multiorgan Dysfunction: A Case Report

Thrombocytopenia, anasarca, fever, reticulin fibrosis, and organomegaly (TAFRO) syndrome is an extremely rare and potentially life-threatening inflammatory disorder of unknown cause and sometimes necessitates intensive care due to complex pathological conditions, including respiratory failure, renal dysfunction, circulatory failure, and infection. However, reports detailing intensive care management of TAFRO syndrome remain limited. A 65-year-old woman was diagnosed with TAFRO syndrome, presenting with progressive edema, significant pleural and ascitic effusions, thrombocytopenia, fever around 37.5-38°C, acute kidney injury, and Castleman disease-like features on lymph node biopsy. She was admitted to the intensive care unit (ICU) for management. Treatment included pulse steroid therapy, careful fluid management with frequent assessment of intravascular volume, and hemodialysis. As a result of pleural effusion drainage and high-flow nasal cannula therapy for respiratory failure due to massive pleural effusion, oxygenation and dyspnea improved, allowing for the avoidance of tracheal intubation. Antibiotics and vasopressors were administered to address septic shock caused by a catheter-associated urinary tract infection (CAUTI). With intensive circulatory management and antimicrobial therapy, the patient's renal function and septic shock gradually improved. Following 37 days of ICU management, the patient was discharged to the general ward. This case highlights the successful intensive care management of a patient with severe TAFRO syndrome and multiorgan dysfunction, achieved through intensive circulatory, fluid, and respiratory management in the ICU despite the complexity of the condition.