20-year old man diagnosed and successfully treated for nodular sclerosing Hodgkin lymphoma, 10 years later was found to be HIV+ and started on anti-retroviral therapy. At age 37, he presented with a 4 month history of rash, night sweats and intermittent lymphadenopathy. A right axillary lymph node was removed (specimen A). HHV8 viral load was 760 copies/ml, a level reported "unlikely to be associated with HHV8-associated multicentric Castleman disease" (MCD). No treatment was initiated, although the patient was maintained on anti-retroviral therapy. At age 39, he developed further widespread lymphadenopathy and B-symptoms with an increased HHV8 viral load (1200 copies/ml). A left axillary lymph node biopsy was performed (specimen B). The patient was treated and was in remission for 2 years and again presented with elevated HHV8 viral load (1700 copies/ml) and lymphadenopathy. An enlarged left axillary lymph node was removed (specimen C).