Multicentric Castleman's Disease in a Hepatitis C-Positive Intravenous Drug User: A Case Report

Abstract

Introduction. We report a rare presentation of Castleman's disease in a hepatitis C-positive patient and present a short review of treatments described in other similar case reports and studies. Case Presentation. A 46-year-old male with untreated hepatitis C and a 16-year history of intravenous drug use presented with pleuritic chest pain and bony pain in the knee, hip, and lower back, on a background of unexplained weight loss of 40 kilograms, fevers, night sweats, and repeated infections over the last two years. Examination discovered tender hepatomegaly, a warm right knee effusion, and painless lymphadenopathy. The patient was reactive to Epstein Barr virus and cytomegalovirus; however, HIV and HHV-8 viral testing was negative. Osteomyelitis of vertebrae T8–T11 and septic arthritis of the knee were found on investigation. A lymph node biopsy revealed histology suggestive of plasmacytic Castleman's disease. The patient is to commence rituximab treatment. Conclusion. Castleman's disease continues to present in novel ways, which may lead to difficulties in clinicopathologic diagnosis. A growing body of evidence suggests larger studies are required to determine the best treatment for multicentric Castleman's disease, particularly in patients with a concomitant disease, including hepatitis C.

Castleman Disease: A Great Mimicker of Metastases in Radioiodine Refractory Thyroid Cancer

“…On the other hand, MCD is categorised by histologic evidence of CD in one lymph node group with radiographic or clinical evidence of lymphadenopathy in other regions as well. [5] In our patient, CD was found out in the right-sided levels II, III, and IV lymph nodes. Right-sided cervical nodal chain was the only side of FDG avidity on PET CT.…”

“…Chronic/untreated viral infection, i.e., HCV, EBV, and HHV-8 could initiate the systemic inflammatory response possibly leading to the development of CD. [5] In our patient, the presence of HIV, EBV, or HHV-8 was not checked.…”

Adult Langerhans cell histiocytosis of skull in a patient with synchronous papillary thyroid carcinoma and Castleman disease

“…Furthermore, the aetiology is unclear; however, chronic/ untreated viral infections, such as HCV, EBV, HIV and HHV-8 can induce systemic inflammatory reactions that could lead to CD. [13][14][15] EBV is reportedly related to LCH and PTC. 1 16-18 Our patient did not show the presence of EBV, HHV-8, HCV or HIV infection.…”

“…19–21 PC-CD is maintained by hyperplastic follicles accompanied by large mantle zone with a normal FDC network. 14 19 The most characteristic feature is the presence of mature plasma cells in the interfollicular area. 19 22 Plasma cells are usually polyclonal, 19 23 24 and rarely monotype immunoglobulin, usually lambda light chain.…”

“…19 25 Immunohistochemical staining shows CD20 at the germinal centre, CD3 at the paracortical zone meaning of the normal distribution of B-cell and T-cell compartment, and CD21, CD23 at germinal centre and in interfollicular area that reveals FDC, while CD31, CD34 represents the blood vessels. 14 20 22 CD138 indicates plasma cells. 20 22 …”