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Kondo J, Arinuma Y, Matsueda Y, Hasegawa Y, Muramatsu T, Kanayama Y, Hoshiyama T, Tono T, Tanaka S, Oku K, Yamaoka K. A Patient with Castleman's Disease Initially Manifesting Symmetrical Synovitis with Pitting Edema. Mod Rheumatol Case Rep 2022; 6:309-313. [PMID: 35092673 DOI: 10.1093/mrcr/rxac003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/21/2021] [Accepted: 12/31/2021] [Indexed: 11/13/2022]
Abstract
Castleman's disease (CD), especially multicentric CD (MCD) has been known to manifest a variety of clinical features such as fatigue, anemia, fever and hypergammaglobulinemia. Here, we report a 72-year-old female patient who had complicated severe synovitis, as an initial manifestation of the disease, lastly diagnosed as MCD. Initially, she had been diagnosed as remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome because of bilateral leg pitting edema with significant c-reactive protein and matrix metalloproteinase-3 elevation but no disease-specific autoantibodies. Promptly, corticosteroid (CS) and additionally weekly methotrexate (MTX) was introduced, but her leg edema and inflammatory findings did not adequately come to be a remission. A lymph node biopsy from the groin region was performed because multiple lymph node swelling in ultrasound examination appeared even after introducing treatments, which revealed mixed-type CD. Multiple lymphadenopathies were observed in the axilla and inguinal region, finally, we diagnosed her as idiopathic MCD and introduced tocilizumab (TCZ) which significantly improved leg edema as well as inflammatory findings. As is shown in this case, manifestations included in RS3PE syndrome could be one of the clinical phenotypes in MCD, which should be considered as a differential diagnosis of MCD.
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Affiliation(s)
- Junichi Kondo
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yoshiyuki Arinuma
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yu Matsueda
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yasuhiro Hasegawa
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
| | - Takumi Muramatsu
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yoshiro Kanayama
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
| | - Takayuki Hoshiyama
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
| | - Toshihiro Tono
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
| | - Sumiaki Tanaka
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
| | - Kenji Oku
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
| | - Kunihiro Yamaoka
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
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Gu H, Liu T, Zhu L, Zhao L, Fan J. A multidisciplinary collaborative model based on single-port thoracoscopy for the treatment of giant mediastinal lymph node hyperplasia: a case report. J Int Med Res 2021; 49:3000605211062780. [PMID: 34918977 PMCID: PMC8725231 DOI: 10.1177/03000605211062780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Mediastinal unicentric Castleman disease (UCD) frequently manifests as a hyper-enhancing lymph node mass and is often surgically curable. However, because of excessive vascularisation and adhesion to important surrounding structures, surgery is often associated with severe haemorrhage that is often difficult to control thoracoscopically. Therefore, thoracotomy is often preferred, which increases the trauma to the patient and affects postoperative recovery. Here, we describe the case of a 30-year-old male patient with a large upper mediastinal lymph node (7 × 5 × 4 cm) that was compressing his superior vena cava. The distribution of nutritive arteries of the mass was analysed in detail, and the main branches were embolised prior to surgery. With the assistance of preoperative isovolumetric haemodilution, we achieved complete resection through single-port thoracoscopy, with only minor haemorrhage, which enabled the patient to recover rapidly. This multidisciplinary collaborative model, based on single-port thoracoscopic surgery, may be of wide practical use for the treatment of mediastinal UCD.
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Affiliation(s)
- Haihua Gu
- Department of Thoracic Surgery, The Second Affiliated Hospital, School of Medicine, 12377Zhejiang University, Zhejiang University, Hangzhou, P.R. China
| | - Tianshu Liu
- Department of Thoracic Surgery, The Second Affiliated Hospital, School of Medicine, 12377Zhejiang University, Zhejiang University, Hangzhou, P.R. China
| | - Ling Zhu
- Department of Thoracic Surgery, The Second Affiliated Hospital, School of Medicine, 12377Zhejiang University, Zhejiang University, Hangzhou, P.R. China
| | - Lufeng Zhao
- Department of Thoracic Surgery, The Second Affiliated Hospital, School of Medicine, 12377Zhejiang University, Zhejiang University, Hangzhou, P.R. China
| | - Junqiang Fan
- Department of Thoracic Surgery, The Second Affiliated Hospital, School of Medicine, 12377Zhejiang University, Zhejiang University, Hangzhou, P.R. China
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Adil Alsinan T, Ahmad Robaidi H, Neamatallah Saleh W. A Case Report of Subclinical Myasthenia Gravis Associated with Castleman's Disease. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e930948. [PMID: 34115743 PMCID: PMC8207541 DOI: 10.12659/ajcr.930948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Castleman's disease is defined as a benign lymphoproliferative disorder of uncertain origin. It is most commonly found in the area of mediastinum. Castleman's disease is classified based on pathological features into hyaline-vascular, plasma cell, and mixed variants, which the hyaline-vascular variant is the commonest in association with Myasthenia Gravis. Castleman's Disease have been very rarely reported in Myasthenia Gravis, as it is associated with various clinical abnormalities. The enlarged localized lymph node is mainly diagnosed by incidental radiological findings due to the enlargement of thymus gland or by compression symptoms. CASE REPORT Here we report a case revolves around a 31-year-old Saudi woman who presented with a 2 years history of exertional dyspnea associated with mouth and eye ulcers. There were no other associated symptoms such as muscular weakness, rapid fatigue or drooping of the eyelids. She was referred to our institution for further investigations and management. She was diagnosed with a mediastinal thymoma that was detected based on a positive serology of antibody anti-acetylcholine receptor (AChR) testing and a computed tomography (CT) scan findings, she eventually underwent a bilateral thoracoscopic thymectomy. CONCLUSIONS The aim of this case report is to add more to the literature by reporting a rare case of an asymptomatic subclinical Myasthenia Gravis associated with Castleman's disease. It highlights the importance of considering a Castleman's Disease in an asymptomatic case who presented with a mediastinal mass and in order to avoid an unusual intraoperative finding such as massive bleeding by performing a biopsy and an angiography preoperatively.
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Affiliation(s)
| | - Hassan Ahmad Robaidi
- Department of Thoracic Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Waleed Neamatallah Saleh
- Department of Thoracic Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Sun DP, Chen WM, Wang L, Wang Z, Liang JH, Zhu HY, Fan L, Wu YJ, Xu W, Li JY. Clinical characteristics and immunological abnormalities of Castleman disease complicated with autoimmune diseases. J Cancer Res Clin Oncol 2021; 147:2107-2115. [PMID: 33544201 PMCID: PMC8164599 DOI: 10.1007/s00432-020-03494-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 12/02/2020] [Indexed: 01/09/2023]
Abstract
Purpose To explore the clinical features and immunological mechanisms of Castleman disease (CD) complicated with autoimmune diseases (AID). Methods We explored the prevalence and clinical manifestations of CD complicated with AID by reviewing clinical, pathological, and laboratory data of 40 CD patients retrospectively, and then explored abnormal immune mechanisms in the co-existence of the two entities by monitoring lymphocyte subsets in peripheral blood. Results Paraneoplastic pemphigus, autoimmune hemolytic anemia, Sjogren’s syndrome, myasthenia gravis, and psoriasis were found to be coexisted with CD in 9/40 (22.5%) patients with different sequence of onset. No bias in the clinical and histological type of CD was observed for the occurrence of AID. CD patients with AID were more likely to have skin and/or mucous membrane damage and pulmonary complications, and presented elevated erythrocyte sedimentation rate, hypergammaglobulinemia, and positive autoantibodies than those without AID (p < 0.05). Deregulated cellular and innate immune responses as indicated by decreased CD3+ T cells and increased natural killer cells were observed in peripheral blood of CD patients with AID (p < 0.05). UCD patients with AID were successfully treated with surgery and immunosuppressive therapy. MCD complicated by AID relieved with immunosuppressors, cytotoxic chemotherapy, and rituximab. Conclusion Systemic inflammation/immunological abnormalities and organ dysfunction were associated with the occurrence of AID in CD. Impairment of cellular and innate immunity may be a candidate etiology for the coexistence of the two entities.
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Affiliation(s)
- Dao-Ping Sun
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.,Department of Hematology, Jining No. 1 People's Hospital, Jining, 272011, China
| | - Wen-Ming Chen
- Department of Oncology, Jining No. 1 People's Hospital, Jining, 272011, China
| | - Li Wang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.,Pukou CLL Center, Nanjing, 210000, China
| | - Zhen Wang
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Jin-Hua Liang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.,Pukou CLL Center, Nanjing, 210000, China
| | - Hua-Yuan Zhu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.,Pukou CLL Center, Nanjing, 210000, China
| | - Lei Fan
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.,Pukou CLL Center, Nanjing, 210000, China
| | - Yu-Jie Wu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.,Pukou CLL Center, Nanjing, 210000, China
| | - Wei Xu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China. .,Pukou CLL Center, Nanjing, 210000, China.
| | - Jian-Yong Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China. .,Pukou CLL Center, Nanjing, 210000, China.
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Wada M, Nagata A, Kawashima A, Kagawa K. An Autopsy Case of TAFRO Syndrome with Type II Respiratory Failure. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e926721. [PMID: 33048915 PMCID: PMC7568526 DOI: 10.12659/ajcr.926721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Patient: Male, 66-year-old Final Diagnosis: TAFRO syndrome Symptoms: Appetite loss • dyspnea • general fatigue Medication: — Clinical Procedure: Biopsy Specialty: Hematology
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Affiliation(s)
- Mikio Wada
- Fukuchiyama City Hospital Ooe-branch, Fukuchiyama, Kyoto, Japan
| | - Akihiro Nagata
- Department of Pathology, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan
| | - Atsushi Kawashima
- General Internal Medicine, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan
| | - Keizo Kagawa
- General Internal Medicine, Fukuchiyama City Hospital, Fukuchiyama, Kyoto, Japan
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Abdelmeguid A, Rojansky R, Berry GJ, Dewan K. Dysphagia and Dysphonia, a Pairing of Symptoms Caused by an Unusual Pair of Diseases: Castleman's Disease and Myasthenia Gravis. Ann Otol Rhinol Laryngol 2020; 130:319-324. [PMID: 32812444 DOI: 10.1177/0003489420949581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To describe a case of coincident Castleman's disease and myasthenia gravis that initially presented as rapidly progressive dysphagia and dysphonia and to review the unique pathophysiology of these two uncommon diagnoses. METHODS Case report and literature review. RESULTS Castleman's disease, angiofollicular or giant lymph node hyperplasia, is a rare benign lymphoid proliferation. Traditionally, the disease is classified based on histologic and clinical characteristics. Fewer than 10 cases with concurrent myasthenia gravis have been reported. Myasthenia gravis and thymic epithelial tumors are both associated with acetylcholine receptor antibody. While patients with isolated Castleman's disease are usually asymptomatic, those who have concurrent myasthenia gravis and undergo surgical treatment are at increased risk of postoperative myasthenic crisis. Both pre- and postoperative plasmapheresis are suggested to improve muscle strength and prevent severe postoperative complications. CONCLUSIONS In the setting of multiple cranial neuropathies including velopalatal insufficiency and bilateral ptosis it is important to consider myasthenia gravis. Castleman's disease occurs rarely in conjunction with myasthenia gravis but may increase the risk of myasthenic crisis.
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Affiliation(s)
- Ahmed Abdelmeguid
- Division of Laryngology, Otolaryngology - Head and Neck Surgery, Stanford University, Palo Alto, CA, USA
| | - Rebecca Rojansky
- Department of Pathology, Stanford University, Palo Alto, CA, USA
| | - Gerald J Berry
- Department of Pathology, Stanford University, Palo Alto, CA, USA
| | - Karuna Dewan
- Division of Laryngology, Otolaryngology - Head and Neck Surgery, Stanford University, Palo Alto, CA, USA
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Wang YQ, Li SQ, Guo F. Video-assisted thoracoscopic surgery is a safe and effective method to treat intrathoracic unicentric Castleman's disease. BMC Surg 2020; 20:127. [PMID: 32522182 PMCID: PMC7285469 DOI: 10.1186/s12893-020-00789-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 06/01/2020] [Indexed: 12/01/2022] Open
Abstract
Background Castleman’s disease (CD) is a rare non-clonal lymphadenopathy. Application of video-assisted thoracoscopic surgery (VATs) in intrathoracic unicentric Castleman’s disease (UCD) is rarely reported. This study is aimed to clarify the role of VATs for diagnosis and treatment in intrathoracic UCD. Methods The authors reviewed and identified patients who had received a histologic diagnosis of CD through VATs at our hospital from January2010 to June 2018. Clinical and radiologic variables, histopathology, type of approach, complications, and long-term effect were analyzed to evaluate the safety and efficacy of VATs. Results A total of 10 patients were included in this study, with 8 hyaline vascular type and 2 plasma cell type. The mean maximum diameter of the lesions was 4.66 cm. Nine cases underwent complete surgical excision by VATs, and 1 case was converted to thoracotomy. All patients had no postoperative complications. With a median follow-up of 5 years (range: 1–9 years), no tumor recurrence was found in 9 patients receiving complete tumor resection, and 1 patient with incomplete tumor resection remained symptom free without clinical or radiographic progression. Conclusions VATs is an alternative, minimally invasive technique for the diagnosis and treatment in patients with intrathoracic UCD.
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Affiliation(s)
- Yan-Qing Wang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, No 1 ShuaiFuYuan Street, Dong Cheng District, Beijing, People's Republic of China
| | - Shan-Qing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, No 1 ShuaiFuYuan Street, Dong Cheng District, Beijing, People's Republic of China
| | - Feng Guo
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730, No 1 ShuaiFuYuan Street, Dong Cheng District, Beijing, People's Republic of China.
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Fein AS, Trejo Bittar HE, Shende MR, Scalzetti EM, Ko MW. Castleman Disease Presenting with Pseudotumour Cerebri and Myasthenia Gravis: A Case Report and Literature Review. Neuroophthalmology 2018; 43:185-191. [PMID: 31312243 DOI: 10.1080/01658107.2018.1484932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 05/30/2018] [Accepted: 06/01/2018] [Indexed: 12/19/2022] Open
Abstract
Castleman disease (CD) is a rare lymphoproliferative disorder that may present with various autoimmune, inflammatory, or neurologic syndromes. This is a case of a 21-year-old woman who presented with signs and symptoms of pseudotumour cerebri (PTC) who subsequently developed myasthenia gravis (MG), and was incidentally found to have a large mass in the posterior mediastinum. Upon resection, the mass was classified as unicentric CD involved with follicular dendritic cell sarcoma. Following treatment with IVIG in the setting of progressive weakness and dyspnea, she has had complete symptom resolution while maintained on a low dose of pyridostigmine for the last two years. There are 13 cases of MG and five cases of optic disc edema described as PTC associated with CD in the literature, but to our knowledge, this is the sole case reported of the intersection of all three conditions in one patient. Increased serum levels of interleukin-6 and vascular endothelial growth factor may provide clues as to the association of CD with these neurologic syndromes.
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Affiliation(s)
| | | | - Manisha R Shende
- Department of Cardiothoracic Surgery.,University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ernest M Scalzetti
- Department of Radiology.,SUNY Upstate Medical University, Syracuse, NY, USA
| | - Melissa W Ko
- Department of Neurology, University Health Care Center.,Department of Ophthalmology.,SUNY Upstate Medical University, Syracuse, NY, USA
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A Case of Spondyloarthritis in Patient Affected by Unicentric Castleman's Disease Effectively Managed with Surgery Resection and Tocilizumab Treatment. Case Rep Rheumatol 2018; 2018:5067239. [PMID: 29610697 PMCID: PMC5828050 DOI: 10.1155/2018/5067239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 12/04/2017] [Accepted: 12/12/2017] [Indexed: 11/17/2022] Open
Abstract
A 38-year-old woman was referred to our hospital for rheumatologic manifestations (migrant arthritis and tenosynovitis), without psoriasis or family history of psoriasis, gastroenteric manifestations, or recent genitourinary infections. The instrumental and laboratory tests have suggested a diagnosis of undifferentiated seronegative HLA-B27-positive spondyloarthritis with predominantly peripheral involvement. The symptoms were very severe and resistant to anti-inflammatory drugs and steroids. She had a history of hyaline-vascular unicentric Castleman's disease (HBV, HIV, and HHV-8 negative) treated with surgery resection. After a first pharmacological attempt with sulfasalazine (suspended for urticarial rash), we managed the patient with monotherapy tocilizumab 8 mg/kg, with full response of rheumatologic manifestations. The efficacy of tocilizumab was confirmed even after a follow-up of three years. Our experience seems to describe a new late-onset autoimmune disease (only 21 cases described in literature) potentially related to Castleman's disease. The patient experienced marked improvement from IL-6-based therapy (tocilizumab).
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Testori A, Voulaz E, Alloisio M, Errico V, Cariboni U, De Simone M, Cioffi U. Multicentric castleman's disease resembling metastatic lung carcinoma. A case report. Clin Case Rep 2018. [PMID: 29531720 PMCID: PMC5838266 DOI: 10.1002/ccr3.1381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
A 67‐year‐old patient presented for persistent cough. Computed tomography showed right lower lung opacity associated with mediastinal adenopathy. On suspicion of metastatic pulmonary neoplasm, the patient was submitted to right lower lobectomy with lymphadenectomy. Postoperative histopathology led to the diagnosis of multicentric Castleman's disease.
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Affiliation(s)
- Alberto Testori
- Deparment of General and Thoracic Surgery Humanitas Research Hospital Rozzano Milan Italy
| | - Emanuele Voulaz
- Deparment of General and Thoracic Surgery Humanitas Research Hospital Rozzano Milan Italy
| | - Marco Alloisio
- Deparment of General and Thoracic Surgery Humanitas Research Hospital Rozzano Milan Italy
| | - Valentina Errico
- Deparment of General and Thoracic Surgery Humanitas Research Hospital Rozzano Milan Italy
| | - Umberto Cariboni
- Deparment of General and Thoracic Surgery Humanitas Research Hospital Rozzano Milan Italy
| | | | - Ugo Cioffi
- Deparment of Surgery University of Milan Milan Italy
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Aoki T, Wada M, Kawashima A, Hirakawa K, Nagata A, Kagawa K. Tocilizumab-resistant TAFRO Syndrome Complicated by Type II Respiratory Failure. Intern Med 2017; 56:3249-3254. [PMID: 29021431 PMCID: PMC5742402 DOI: 10.2169/internalmedicine.8360-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A 66-year-old man with a several year history of thrombocytopenia, pleural effusion and ascites, anasarca, and organomegaly presented with general fatigue, appetite loss, dyspnea with type II respiratory failure. The precise history of the patient and the re-evaluation of lymph node and bone marrow biopsies conducted by the previous physician indicated TAFRO syndrome. The patient's laboratory data improved for a year with tocilizumab, but then worsened to the point that the patient required artificial ventilation due to the deterioration of type II respiratory failure. The replacement of tocilizumab with rituximab yielded a steady improvement, but it was necessary to address the patient's persistent respiratory failure. Peripheral nerve disorder might have been involved with the patient's respiratory failure.
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Affiliation(s)
- Tatsuya Aoki
- General Internal Medicine, Fukuchiyama City Hospital, Japan
| | - Mikio Wada
- General Internal Medicine, Fukuchiyama City Hospital, Japan
| | | | | | - Akihiro Nagata
- Department of Pathology, Fukuchiyama City Hospital, Japan
| | - Keizo Kagawa
- General Internal Medicine, Fukuchiyama City Hospital, Japan
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Wang S, Chen SW, Cai SL, Jin BY. A case report of retroperitoneal pararenal Castleman's disease associated with myasthenia gravis. World J Surg Oncol 2014; 12:331. [PMID: 25380562 PMCID: PMC4234864 DOI: 10.1186/1477-7819-12-331] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 10/20/2014] [Indexed: 11/25/2022] Open
Abstract
Background Castleman’s disease (CD) is a relatively rare disorder characterized by the benign proliferation of lymphoid tissue. The combination of an occurrence of retroperitoneal pararenal CD with myasthenia gravis (MG) is extremely rare. Case presentation The patient was admitted to our hospital for investigation of a retroperitoneal pararenal tumor which had been coincidentally diagnosed at a local hospital where he was admitted because of MG. The patient subsequently underwent an exploratory laparotomy and suffered from postoperative myasthenic crisis. Pathological examination revealed a left retroperitoneal mass of CD (hyaline vascular type). There was no recurrence of disease found after 7 months. Conclusions CD with MG is a rare condition. Postoperative myasthenic crisis is a severe complication. The possibility of its occurrence must be in physicians’ minds and the risk of postoperative myasthenic crisis must be carefully considered when evaluating MG patients undergoing surgery.
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Affiliation(s)
| | - Shan-Wen Chen
- The first affiliated hospital of Zhejiang University School of Medcine, Qingchun Road NO,79, Hangzhou, Zhejiang 310003, China.
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