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Background: Flower-shaped nuclei in plasma cells are rare in multiple myeloma. Case presentation: We report on an 88-year-old male who presented with a mass lesion in the clavicular region. A biopsy of the mass revealed an increase in mature plasma cells with round nuclei. In contrast, a bone marrow examination showed increased plasma cells with flower-shaped nuclei. The patient tested negative for human T-lymphotropic virus type-1 and was diagnosed with multiple myeloma. Conclusions: While multiple myeloma is known for intra-tumor heterogeneity, reports of morphological heterogeneity based on the site of tumor sampling are limited. In this case, the presence of plasma cells with flower-shaped nuclei enabled the identification of site-dependent morphological tumor heterogeneity.

Acute kidney injury (AKI) due to delayed methotrexate (MTX) elimination is a severe potential adverse event of high-dose (HD)-MTX treatment. However, no treatment for HD-MTX-induced AKI has been established. In addition, there are no reports of corticosteroids being administered for HD-MTX-induced AKI. Here, we report the case of a 77-year-old male with central nervous system lymphoma, who developed an AKI after the second course of HD-MTX. He underwent charcoal hemoperfusion and hemodialysis immediately after the development of the AKI. He also received short-term corticosteroid therapy due to inflammatory findings and a positive drug-induced lymphocyte stimulation test for MTX. Our case suggests that short-term corticosteroid therapy consecutive to hemodialysis and charcoal hemoperfusion may be useful for AKI induced by delayed MTX elimination even in the elderly.

TAFRO syndrome is a systemic inflammatory disease characterized by thrombocytopenia and anasarca. It results from hyperinflammation and produces severe cytokine storms. Severe acute respiratory syndrome coronavirus 2, which led to the coronavirus disease 2019 (COVID-19) pandemic, also causes cytokine storms. COVID-19 was reported to be associated with various immune-related manifestations, including multisystem inflammatory syndrome, hemophagocytic syndrome, vasculitis, and immune thrombocytopenia. Although the pathogenesis and complications of COVID-19 have not been fully elucidated, the pathogeneses of excessive immunoreaction after COVID-19 and TAFRO syndrome both involve cytokine storms. Since the COVID-19 pandemic, there have been a few case reports about the onset of TAFRO syndrome after COVID-19 or COVID-19 vaccination. Castleman disease also presents with excessive cytokine production. We reviewed the literature about the association between TAFRO syndrome or Castleman disease and COVID-19 or vaccination against it. While the similarities and differences between the pathogeneses of TAFRO syndrome and COVID-19 have not been investigated previously, the cytokines and genetic factors associated with TAFRO syndrome and COVID-19 were reviewed by examining case reports. Investigation of TAFRO-like manifestations after COVID-19 or vaccination against COVID-19 may contribute to understanding the pathogenesis of TAFRO syndrome.