Multicentric Castleman disease of hyaline vascular variant presenting with unusual systemic manifestations: a case report

Background

Castleman disease is a rare lymphoproliferative disorder presenting with localized or disseminated lymphadenopathy and systemic manifestations. It can be categorized in numerous ways, such as unicentric versus multicentric, histopathological variants (hyaline-vascular, plasma cell, and mixed), or subtypes based on causative viral infections (human immunodeficiency virus, human herpesvirus-8, or Kaposi sarcoma herpesvirus). Presentation ranges from asymptomatic to symptoms involving multiple organs. Even though the exact mechanism of pathogenesis is unknown, treatment is directed toward possible etiologies such as interleukin-6, cluster of differentiation 20, and viral agents.

Case presentation

A 36-year-old Sri Lankan woman presented with generalized body swelling and foamy urine of 2 weeks’ duration. Examination revealed pallor; generalized edema; axillary, cervical, and inguinal lymphadenopathy; hypertension; and hepatomegaly. Investigations showed bicytopenia, nephrotic range proteinuria with hypoalbuminemia, hypogammaglobulinemia, and features of hyaline-vascular type Castleman disease in a lymph node biopsy. She was managed with rituximab and had good clinical improvement.

Conclusions

Castleman disease has a broad spectrum of clinical manifestations, disease pathogeneses, and associations and/or complications. Medical professionals need to be familiar with this spectrum because timely diagnosis and aggressive targeted therapy are the cornerstones of managing these patients.

Effects of mesophilic and thermophilic composts on suppression of Fusarium root and stem rot of greenhouse cucumber

Three composts were tested for their ability to suppress root and stem rot caused by the soil borne fungal pathogen Fusarium oxysporum f. sp. radicis-cucumerinum (FORC) on cucumber. Two of the composts were prepared from separated dairy solids either by windrow (WDS) or vermicomposting (VMC) while the third, obtained from International Bio-Recovery (IBR), was prepared from vegetable refuse using aerobic digestion. Three sets of potting mixes were prepared by mixing the composts with sawdust at varying ratios, and seeded with cucumber cv. Corona. After 14 days of growth in the greenhouse, inoculum of FORC (20 mL of 5 x 10(6) micro-conidia per mL) was applied to each pot at three different times (14, 21, and 35 days). In unamended inoculated pots, the pathogen caused stunted growth and reduced flowers. Amendment of WDS in the potting mix suppressed these symptoms, while VMC and IBR had no effect. All three composts reduced the FORC colony forming units (cfu) at the end of the experiment (10 weeks). There was a large increase of fluorescent bacteria near the vicinity of roots particularly in WDS amended potting mixes. When water extracts of the composts were plated onto acidified potato dextrose agar (APDA), only IBR contained a potent thermostable inhibitor to FORC. This inhibitor was removed by activated charcoal but was not partitioned into petroleum ether at acid, basic, or neutral pH. Inhibition of FORC by IBR was not due to electrical conductivity or trace elements in the compost. Contrasting effectiveness of the WDS and VMC made from the same waste suggests that composting method can influence the disease suppression properties of the finished compost.