Successful Treatment with Rituximab in a Patient with Castleman's Disease Complicated by Systemic Lupus Erythematosus and Severe Autoimmune Thrombocytopenia

Castleman disease presenting as lymphadenopathy in a female with systemic lupus erythematosus: A rare case report

Castleman disease is an infrequent disease that affects the lymph nodes and related tissues. The condition may manifest with lymphadenopathy, characterized by the enlargement of the lymph nodes, alongside additional symptoms such as high fever, nocturnal sweating, exhaustion, and loss of body mass. The diagnosis of Castleman disease typically entails a multifaceted approach that includes a physical examination, imaging modalities, and a biopsy of the lymph nodes that are affected. The selection of treatment modalities is contingent upon the classification and extent of the disease. Systemic lupus erythematosus (SLE) has been identified as a potential risk factor for the development of lymphoma, a condition that may manifest with lymphadenopathy resembling Castleman disease. Hence, it is crucial for individuals diagnosed with SLE and exhibiting lymphadenopathy to undergo a comprehensive assessment to exclude the possibility of any other associated disease. Although lymphadenopathy is a common symptom shared by both Castleman illness and SLE, these diseases have distinct etiologies and are treated in different ways. Seeking advice from a healthcare practitioner is crucial in order to obtain an accurate diagnosis and effective treatment. A 39-year-old female patient with a history of SLE since 18 years ago and lupus nephritis since 6 years ago which treated with Mycophenolic Acid 2 g daily, Hydroxychloroquine 400 mg daily, and low doses of Prednisolone. Also, Mycophenolic Acid has discontinued for her 5 months ago due to the reduction of proteinuria and the control of the disease. Although the association of Castleman Disease with SLE is infrequent, establishing a connection between them could prove advantageous in the treatment and etiology of diseases.

Mimic or coincidentally? TAFRO syndrome and systemic lupus erythematosus: A case-based review

Castleman's disease (CD) is a rare, systemic disease with histopathological features of angiofollicular lymph node hyperplasia. In the literature, there are case-level reports that mimic or coexist with systemic lupus erythematosus (SLE) clinically and in the laboratory. Is this condition two separate diseases or is it an imitation of each other? A 73-year-old female patient was admitted to our clinic with arthritis, lymphadenopathy, fever, weight loss, and malar rash. He had a history of idiopathic thrombocytopenic purpura and thrombosis in the right leg tibialis posterior and dorsalis pedis arteries. Excisional lymphadenopathy biopsy indicated a diagnosis of hyaline-vascular-type CD. She had anti-nuclear antibody >1/80 homogeneous pattern, anti-double stranded DNA (anti-dsDNA), Anti-Smith (Sm) antibody positivity, hypocomplementemia (C3 and C4), pleural effusion, and pericardial effusion. For this reason, the classification criteria of the European League Against Rheumatism/American College of Rheumatology were studied. Clinical findings, idiopathic thrombocytopenic purpura history, antibody positivity, malar rash, and arthritis led us to the diagnosis of SLE. She was treated with 1 mg/kg/day prednisolone and hydroxychloroquine 200 mg 2 × 1. Azathioprine 2.5 mg/kg daily was added to the patient whose complaints did not improve. In the follow-ups, she completely recovered clinically and laboratory. SLE and CD are systemic diseases that overlap in many ways. The literature review shows that these two diseases may mimic each other or may coexist. This situation may be a reflection of a pathophysiological process that has not yet been clarified. This confusing process also affects the treatment decision. This confusing process also affects the treatment decision.

Systemic lupus erythematosus complicated with Castleman disease: a case-based review

Systemic lupus erythematosus (SLE) is a complex, chronic, multi-systemic autoimmune disease, characterized by miscellaneous clinical findings. Castleman disease (CD) is a rare lymphoproliferative disorder that may present with systemic symptoms. Herein, a SLE case complicated with CD is reported by comparing her clinical findings with previously reported patients. We reviewed the literature regarding cases of "Castleman disease" and "Systemic lupus erythematosus" by searching medical journal databases in MEDLINE, EMBASE, Scopus, and Web of Science. A case of a 16-year-old girl with SLE who had intraabdominal lymphadenopathy detected both by ultrasonography and abdominal magnetic resonance imaging is presented. The excision of the lymph node was performed by pediatric surgeons. Histopathological examination was compatible with CD. Hydroxychloroquine and steroid treatments were started after the operation. She achieved remission in 3 months. In the literature research, we found 10 articles describing 17 patients. To our best of knowledge, the presented case was the third pediatric case in the literature with SLE and coexistent CD. This case report and literature review suggests that CD should be considered while evaluating and following patients with autoimmune diseases.