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Kojima D, Yamaguchi S, Hashiguchi A, Hayashi K, Uchiyama K, Yoshimoto N, Adachi K, Nakayama T, Nishioka K, Tajima T, Morimoto K, Yoshino J, Yoshida T, Monkawa T, Kanda T, Itoh H. Case report: Importance of early and continuous tocilizumab therapy in nephrotic syndrome associated with idiopathic multicentric Castleman disease: A case series. Front Med (Lausanne) 2023; 9:1037032. [PMID: 36698794 PMCID: PMC9868391 DOI: 10.3389/fmed.2022.1037032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/14/2022] [Indexed: 01/10/2023] Open
Abstract
Idiopathic multicentric Castleman disease (iMCD) is a systemic and polyclonal lymphoproliferative disease involving multiple organs, including the kidneys, due to the overproduction of interleukin-6 (IL-6). Recently, several reports have suggested that excessive IL-6 actions in iMCD could have a causal relationship with the development of diverse histopathological renal manifestations that cause nephrotic syndrome. However, the treatment for such cases remains unclear. We report a series of three cases of nephrotic syndrome due to iMCD that helps to delineate the importance of early and continuous therapy with the anti-interleukin-6 receptor antibody tocilizumab. First, treatment was suspended for infectious control, and the patient presented with nephrotic syndrome due to diffuse mesangial and endocapillary hypercellularity without immune deposits complicating acute kidney injury. Second, iMCD was treated with prednisolone alone. The patient suddenly developed nephrotic syndrome due to immune-complex glomerulonephritis, not otherwise specified, complicated with acute kidney injury. In the third case, nephrotic syndrome secondary to membranous glomerulonephritis was diagnosed, with a skin rash and IgE antibodies to tocilizumab, and was therefore treated with prednisolone alone. In contrast to the first two cases, the third progressed to end-stage renal disease on hemodialysis. Taken together, this series suggests that clinicians should maintain clinical vigilance for iMCD as a possible underlying component of nephrotic syndrome, since iMCD presents with a variety of renal pathologies. Prompt initiation and continuous administration of tocilizumab are likely key determinants of renal outcomes in such cases. In particular, when tocilizumab is suspended due to infection or in the perioperative period, consideration of its expeditious resumption should be made, taking into account both the withdrawal period and systemic conditions.
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Affiliation(s)
- Daiki Kojima
- Division of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shintaro Yamaguchi
- Division of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan,*Correspondence: Shintaro Yamaguchi,
| | - Akinori Hashiguchi
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Kaori Hayashi
- Division of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kiyotaka Uchiyama
- Division of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Norifumi Yoshimoto
- Division of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Keika Adachi
- Division of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takashin Nakayama
- Division of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ken Nishioka
- Division of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takaya Tajima
- Division of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kohkichi Morimoto
- Apheresis and Dialysis Center, Keio University School of Medicine, Tokyo, Japan
| | - Jun Yoshino
- Division of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tadashi Yoshida
- Apheresis and Dialysis Center, Keio University School of Medicine, Tokyo, Japan
| | - Toshiaki Monkawa
- Division of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan,Medical Education Center, Keio University School of Medicine, Tokyo, Japan
| | - Takeshi Kanda
- Division of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Itoh
- Division of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Sugawara E, Sato T, Amasaki Y, Katsumata K. Successful treatment with tocilizumab for refractory anemia and slowly progressive renal glomerulosclerosis in multicentric Castleman disease: A case report. Medicine (Baltimore) 2022; 101:e28941. [PMID: 35212301 PMCID: PMC8878775 DOI: 10.1097/md.0000000000028941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/09/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Multicentric Castleman disease (MCD) is a rare lymphoproliferative disorder accompanied by systemic symptoms characterized by polyclonal hypergammaglobulinemia and chronic inflammation due to overexpression of interleukin-6. Histological heterogeneity of renal involvement in MCD has been described, although the number of reports is limited. Tocilizumab, a humanized anti-interleukin-6 receptor antibody, has been reported to be effective for MCD. PATENT CONCERNS A 64-year-old man experienced refractory anemia and slowly progressive renal dysfunction with proteinuria, accompanied by persistent inflammation for 11 years. DIAGNOSIS Two renal biopsies were obtained. The first biopsy performed 7 years before admission revealed non-specific interstitial inflammation, whereas the second biopsy demonstrated global sclerosis in most glomeruli and interstitial fibrosis. The patient had multiple lymphadenopathies. Cervical lymph node biopsy histological findings were compatible with plasma cell type Castleman disease. The patient had no evidence of human hepatitis virus-8 infection. INTERVENTION The patient was treated with 60 mg/d prednisolone followed by 8 mg/kg intravenous tocilizumab every 2 weeks. OUTCOME His anemia significantly improved, as well as a marked reduction in proteinuria and stabilization of renal function. He did not experience renal function during the 2-years follow-up period. LESSONS The heterogeneity of the renal manifestations of MCD sometimes makes early diagnosis difficult. We need to interpret the histological findings of the renal biopsy carefully. For advanced-stage renal diseases, tocilizumab might be an effective treatment strategy for MCD.
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Affiliation(s)
- Eri Sugawara
- Department of Rheumatology, Tonan Hospital, Sapporo, Japan
| | - Taiki Sato
- Department of Rheumatology, Tonan Hospital, Sapporo, Japan
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Horino T, Kashio T, Inotani S, Ishihara M, Ichii O. Membranous Nephropathy Associated With Multicentric Castleman Disease-Efficacy of Interleukin 6 Antibody for Nephrotic Syndrome. J Clin Rheumatol 2022; 28:e1-e2. [PMID: 34897198 DOI: 10.1097/rhu.0000000000001810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Taro Horino
- From the Departments of Endocrinology, Metabolism, and Nephrology
| | - Takeshi Kashio
- From the Departments of Endocrinology, Metabolism, and Nephrology
| | - Satoshi Inotani
- From the Departments of Endocrinology, Metabolism, and Nephrology
| | | | - Osamu Ichii
- Laboratory of Anatomy, Department of Basic Veterinary Sciences, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Japan
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Basnayake BMDB, Wazil AWM, Kannangara T, Ratnatunga NVI, Hewamana S, Ameer AM. Multicentric Castleman disease of hyaline vascular variant presenting with unusual systemic manifestations: a case report. J Med Case Rep 2017; 11:135. [PMID: 28501028 PMCID: PMC5429940 DOI: 10.1186/s13256-017-1294-3] [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] [Received: 09/16/2016] [Accepted: 04/07/2017] [Indexed: 12/04/2022] Open
Abstract
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.
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Affiliation(s)
| | - A W M Wazil
- Department of Nephrology, Teaching Hospital Kandy, Kandy, Sri Lanka
| | - T Kannangara
- Department of Medicine, Teaching Hospital Kandy, Kandy, Sri Lanka
| | - N V I Ratnatunga
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - S Hewamana
- Department of Hematology and Hemato-oncology, Lanka Hospitals, Colombo, Sri Lanka
| | - A M Ameer
- Department of Medicine, Teaching Hospital Kandy, Kandy, Sri Lanka
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Temirbekov D, Yazici ZM, Ergelen R, Turgut H, Kayhan FT. Castelman disease of the parotid gland: An unusual entity. Otolaryngol Pol 2014; 68:208-11. [PMID: 24981305 DOI: 10.1016/j.otpol.2013.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 09/24/2013] [Indexed: 10/26/2022]
Abstract
Castleman disease (CD) is a benign lymphoepithelial disorder characterised by abnormal growth of a lymph node. This disease may be seen anywhere along the lymphatic chain but it usually occurs in the mediastinum. Two clinical types (localised and generalised) and three histopathological types (hyaline vascular, plasma cell, and mixed) have been described. We present a case of a 35-year-old female patient with parotid CD of the hyaline-vascular type as an extremely rare entity. We also discuss recent updates on this disease.
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Affiliation(s)
- Dastan Temirbekov
- Department of Otolaryngology - Head and Neck Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
| | - Zahide Mine Yazici
- Department of Otolaryngology - Head and Neck Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Rabia Ergelen
- Department of Otolaryngology - Head and Neck Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Hurriyet Turgut
- Department of Otolaryngology - Head and Neck Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Fatma Tulin Kayhan
- Department of Otolaryngology - Head and Neck Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Efficacy of tocilizumab, a humanized neutralizing antibody against interleukin-6 receptor, in progressive renal injury associated with Castleman's disease. CEN Case Rep 2012; 1:7-11. [PMID: 28509146 DOI: 10.1007/s13730-012-0004-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 01/05/2012] [Indexed: 01/12/2023] Open
Abstract
Castleman's disease is a benign lymphoproliferative disorder in which interleukin-6 (IL-6), a pleiotropic proinflammatory cytokine, is thought to play a pathogenetic role. Presented is the case of a 72-year-old man with Castleman's disease who exhibited progressive renal dysfunction with proteinuria. Renal biopsy revealed mesangial hypercellularity and matrix expansion in most glomeruli and peritubular inflammatory cell infiltration. Immunofluorescence studies showed intense deposition of IgG in a granular pattern along the glomerular basement membrane. Histological features were compatible with membranoproliferative glomerulonephritis accompanied by interstitial inflammatory cell infiltration. Immunohistological analysis showed that IL-6 was abundantly expressed by tubular cells and interstitial macrophages, suggesting involvement of IL-6 in the renal injury. As a result of administration of tocilizumab, a humanized anti-IL-6 receptor antibody, the patient experienced clinical and biochemical improvement of Castleman's disease, including marked reduction of proteinuria and stabilization of renal function. These findings suggest the efficacy of tocilizumab against Castleman's disease and its renal complications.
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Farruggia P, Trizzino A, Scibetta N, Cecchetto G, Guerrieri P, D'Amore ESG, D'Angelo P. Castleman's disease in childhood: report of three cases and review of the literature. Ital J Pediatr 2011; 37:50. [PMID: 22014148 PMCID: PMC3219574 DOI: 10.1186/1824-7288-37-50] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Accepted: 10/20/2011] [Indexed: 12/24/2022] Open
Abstract
Castleman's disease (CD) is a rare, localized or generalized, lymphoproliferative disorder with a frequent mediastinal location, but possible in any lymph node or extra nodal site. It usually appears in young adults whilst it rarely occurs in childhood. There are only about 100 pediatric cases published, five of them in Italy. We report 3 cases of localized Castleman's disease, investigated in our Department in a 3 years period and reviewed the literature.
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Affiliation(s)
- Piero Farruggia
- Unit of Pediatric Hematology and Oncology, "G. Di Cristina" Children's Hospital, A.R.N.A.S., Palermo, Italy
| | - Antonino Trizzino
- Unit of Pediatric Hematology and Oncology, "G. Di Cristina" Children's Hospital, A.R.N.A.S., Palermo, Italy
| | - Nunzia Scibetta
- Unit of Pathology, "Civico e Benfratelli" Hospital, A.R.N.A.S., Palermo, Italy
| | | | - Patrizia Guerrieri
- Unit of Oncological Radiotherapy, "Civico e Benfratelli" Hospital, A.R.N.A.S., Palermo, Italy
| | | | - Paolo D'Angelo
- Unit of Pediatric Hematology and Oncology, "G. Di Cristina" Children's Hospital, A.R.N.A.S., Palermo, Italy
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8
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Al-Amri AM, Abdul-Rahman IS, Ghallab KQ. Castleman's disease: a study of a rare lymphoproliferative disorder in a university hospital. Gulf J Oncolog 2010:25-36. [PMID: 20164006 DOI: 10.4137/cmbd.s2161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2009] [Indexed: 11/05/2022]
Abstract
Castleman's disease (CD) is a group of rare lymphoproliferative disorders sharing characteristic clinical and histological features, and usually accompanied by a marked systemic inflammatory response. Two histological patterns of lymph nodes were described: the hyaline-vascular and plasma-cell types. The former is more common (80-90%) and tends to be localized. The plasma cell type is more aggressive and usually multicentric. It is interesting that the inflammatory manifestations seem to be related to a lymph node lesion, because the systemic symptoms and inflammatory activity can return to normal after surgical excision or successful medical treatment of the disease. We report here our 15-year experience with this rare disease in King Fahd Hospital of the University, Al-Khobar, Saudi Arabia, focusing on the clinical features, therapy, and patients'outcome.
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Affiliation(s)
- A M Al-Amri
- King Fahd University Hospital, Al-Khobar, Saudi Arabia
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Dong Y, Na J, Lv J, Wang R, Chen X, Li N, Ren H. Clinical and laboratory characterization of a large cohort of patients with Castleman disease retrospectively collected from a single center. Leuk Lymphoma 2009; 50:1308-17. [DOI: 10.1080/10428190903060095] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Komaba H, Nakazawa T, Yamaguchi Y, Kumagai S, Fukagawa M. Interleukin-6 receptor inhibition with tocilizumab in various renal involvements associated with multicentric Castleman's disease: a report of three cases. NDT Plus 2008; 1:423-426. [PMID: 28656995 PMCID: PMC5477882 DOI: 10.1093/ndtplus/sfn157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2008] [Accepted: 09/16/2008] [Indexed: 11/13/2022] Open
Abstract
Multicentric Castleman's disease (MCD) is an inflammatory lymphoproliferative disorder characterized by polyclonal hypergammopathy and dysregulated overproduction of interleukin-6 (IL-6). A variety of renal involvements infrequently arise in patients with MCD. However, there is no established treatment for MCD and its associated renal involvements. We present the effects of an anti-IL-6 receptor monoclonal antibody, tocilizumab, on three patients with MCD associated with various renal manifestations. In all three patients, tocilizumab treatment was very effective in reducing proteinuria and stabilizing renal function, as well as improving other clinical symptoms. These findings indicate the pathological significance of IL-6 in renal involvements associated with MCD, and the potential use of tocilizumab in its treatment.
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Affiliation(s)
| | - Takashi Nakazawa
- Department of Clinical Pathology and Immunology, Kobe University School of Medicine, Kobe
| | - Yutaka Yamaguchi
- Department of Pathology, Kashiwa Hospital, The Jikei University School of Medicine, Chiba, Japan
| | - Shunichi Kumagai
- Department of Clinical Pathology and Immunology, Kobe University School of Medicine, Kobe
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Eleftheriou D, Amin T, Hook CE, Auchterlonie I, Houlsby WT, Denison A, Rosendhal K, Davidson JE, Klein N, Brogan PA. Castleman's disease in childhood: a surgically curable mimic of autoimmune disease. Rheumatology (Oxford) 2008; 47:1435-6. [DOI: 10.1093/rheumatology/ken285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Morita-Hoshi Y, Tohda S, Miura O, Nara N. An autopsy case of multicentric Castleman’s disease associated with interstitial nephritis and secondary AA amyloidosis. Int J Hematol 2007; 87:69-74. [DOI: 10.1007/s12185-007-0015-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Revised: 09/11/2007] [Accepted: 09/21/2007] [Indexed: 10/22/2022]
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Barber M, Eguiluz I, Cabrera F, Martín A, Plasencia W, García-Hernández J. Enfermedad de Castleman como causa de síndrome nefrótico e insuficiencia renal en una gestante. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2007. [DOI: 10.1016/s0210-573x(07)74500-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yamagata N, Fujio J, Hirai R, Matsumaru M, Tanimura S, Inokuchi C, Shikai T, Takezako N, Nasu M, Sakata Y, Sata N, Nagai H, Saito K, Miwa A. Marked hepatomegaly due to AA type amyloidosis in a case with Castleman's disease. Int J Hematol 2006; 84:70-3. [PMID: 16867906 DOI: 10.1532/ijh97.05126] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hepatic amyloidosis complicated with Castleman's disease is quite rare. A 48-year-old woman was referred to our hospital with general fatigue, low-grade fever, anemia, thrombocythemia, and liver dysfunction. Physical examination revealed anemia and hepatomegaly and abdominal computed tomography showed marked hepatomegaly and right upper abdominal masses. Technetium-99m pyrophosphate (99mTc-PYP) scintigraphy revealed the diffuse abnormal uptake of the enlarged liver, suggesting amyloid deposition. Liver biopsy showed destruction of the liver structure and the massive deposition of AA type amyloid protein. Surgical resection was performed on the abdominal masses. Histological examination of the masses showed Castleman's disease (plasma cell type). After resection, her fever resolved and the liver size gradually decreased to within the normal range. This case shows that surgical resection of the main lesion is effective for hepatomegaly due to AA type amyloidosis associated with Castleman's disease.
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Affiliation(s)
- Noboru Yamagata
- Department of Hematology, International Medical Center of Japan, Tokyo, Japan.
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Abstract
Castleman's disease (CD) was first described in 1954 and further defined in 1956 by Castleman. Since then much has been learned about the heterogeneity of this condition. Subsequently, three pathologic classifications have been developed (hyaline vascular variant, plasma cell variant, and mixed variant) and two clinical classifications (unicentric [unifocal or localized] and multicentric [multifocal or generalized]). The pathology found with the unicentric presentation is most commonly that of the HV variant. It responds well to surgical resection and is associated with a benign course. The multicentric presentation is rarely composed of lymph nodes with HV pathology, but rather with the plasma cell or mixed pathology. This presentation requires systemic therapy and prognosis is guarded. Associated systemic symptoms are common. There is an increased incidence of CD in patients with HIV. The human herpes virus-8 is associated with nearly all of the HIV-associated CD cases and nearly 50% of non-HIV cases. Interleukin (IL)-6 has also been shown to play a significant role in the pathogenesis of the disease. Paraneoplastic and autoimmune entities are not uncommon in the disorder. Variable benefit has been achieved with single agent chemotherapy, combination chemotherapy, interferon (IFN)-alpha, rituximab, anti-IL-6 receptor antibodies, and thalidomide. Patients with CD are at increased risk for developing frank malignant lymphoma.
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Affiliation(s)
- Angela Dispenzieri
- Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Uthup S, Balachandran K, Ammal VA, Abdul Salam R, George J, Nair GM, Leela M. Renal involvement in multicentric Castleman disease with glomeruloid hemangioma of skin and plasmacytoma. Am J Kidney Dis 2006; 48:e17-24. [PMID: 16860182 DOI: 10.1053/j.ajkd.2006.04.089] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Accepted: 04/17/2006] [Indexed: 12/17/2022]
Abstract
A 47-year-old man presented with fever of unknown origin, generalized weakness, edema, and renal failure. He had left-sided pleural effusion, generalized lymphadenopathy, multiple nontender cutaneous nodules, hepatomegaly, renal failure, and hypergammaglobulinemia. Axillary lymph node biopsy showed findings consistent with Castleman disease of the hyaline vascular type associated with interfollicular plasmacytosis. A renal biopsy performed in view of proteinuria and acute renal failure showed hypercellular glomeruli with capillary loop thickening and double contours consistent with membranoproliferative glomerulonephritis. Skin nodule biopsy showed a glomeruloid hemangioma characterized by dermal proliferation of capillary loops in a nodular manner resembling a glomerulus. He experienced clinical and biochemical remission with steroids. Discontinuation of steroid therapy was associated with recurrence of renal failure, reappearance of nodules, lymphadenopathy, and appearance of bony lytic lesions. Biopsy of bony lytic lesions showed plasmacytoma. The patient achieved complete remission on treatment with steroids and cyclophosphamide and is free of symptoms at the end of 40 months of follow-up. To our knowledge, this is the first case report of the occurrence of membranoproliferative glomerulonephritis, glomeruloid hemangioma of the skin, and plasmacytoma in a patient with multicentric Castleman disease without human immunodeficiency virus infection.
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Affiliation(s)
- Susan Uthup
- Department of Nephrology, Medical College Thiruvananthapuram, Kerala, India.
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Perdaens C, De Raeve H, Goossens A, Sennesael J. POEMS syndrome characterized by glomeruloid angioma, osteosclerosis and multicentric Castleman disease. J Eur Acad Dermatol Venereol 2006; 20:480-1. [PMID: 16643164 DOI: 10.1111/j.1468-3083.2006.01477.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Leung KT, Wong KM, Choi KS, Chau KF, Li CS. Multicentric Castleman's disease complicated by secondary renal amyloidosis. Nephrology (Carlton) 2005; 9:392-3. [PMID: 15663642 DOI: 10.1111/j.1440-1797.2004.00337.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Verbrugghe W, Maes BD, Knockaert DC. Localised plasma-cell type Castleman's disease and AA-amyloidosis cured by resection. A case report and review of the literature. Acta Clin Belg 2005; 60:22-7. [PMID: 15981701 DOI: 10.1179/acb.2005.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Castleman's disease (CD) is a rare atypical lymphoproliferative disorder with frequent, yet less well known renal involvement. We describe the case of a 58-year-old woman with localised abdominal plasma-cell type CD complicated by nephrotic syndrome due to renal amyloidosis. 18Fluorodeoxyglucose (FDG) positron emission tomography (PET) confirmed the unicentric nature. Resection of the mass resulted in regression of the signs of inflammation, a negative FDG-PET and complete remission of the nephrotic syndrome. A review of the literature of renal involvement (incidence, clinical and pathological manifestations, treatment and prognosis) in CD is provided.
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Affiliation(s)
- W Verbrugghe
- Department of Medicine, Division of Nephrology, University Hospital Gasthuisberg, B-3000 Leuven, Belgium
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Mandreoli M, Casanova S, Vianelli N, Pasquali S, Zucchelli P. Remission of nephrotic syndrome due to AA amyloidosis and initiation of glomerular repair after surgical resection of localized Castleman's disease. Nephron Clin Pract 2002; 90:336-40. [PMID: 11867955 DOI: 10.1159/000049070] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To shed further light on the eventual destiny of amyloid kidney deposits after interruption of amylogenic stimulus, we report a case of a 47-year-old woman with nephrotic syndrome due to renal amyloidosis, complicating abdominal Castleman's disease. After 5 courses of therapy with melphalan and prednisolone which failed to improve the nephrotic syndrome or her general clinical condition, and 1 year after the diagnosis of renal amyloidosis, surgical excision of the abdominal mass was performed. Whereas her clinical symptoms and other laboratory findings rapidly improved, the proteinuria took 18 months to disappear. A second renal biopsy, performed 30 months after surgical resection, showed persistence of the amyloid deposits in the same extent. However, electron microscopy revealed subtle reparative phenomena at the epithelial site of the basement membrane. We conclude that proteinuria associated with amyloidosis does not only depend on structural damage and that the new synthesized segment of basement membrane observed by us probably represents a mechanism of repair and the start of a long healing process.
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Affiliation(s)
- Marcora Mandreoli
- Department of Nephrology and Dialysis, M. Malpighi Hospital, Bologna, Italy
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Curioni S, D'Amico M, Quartagno R, Martino S, Dell'Antonio G, Cusi D. Castleman's disease with nephrotic syndrome, amyloidosis and autoimmune manifestations. Nephrol Dial Transplant 2001; 16:1475-8. [PMID: 11427644 DOI: 10.1093/ndt/16.7.1475] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Curioni
- Graduate School of Nephrology, University of Milan, Italy
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Keven K, Nergizoğlu G, Ateş K, Erekul S, Orhan D, Ertürk S, Tulunay O, Karatan O, Ertuğ AE. Remission of nephrotic syndrome after removal of localized Castleman's disease. Am J Kidney Dis 2000; 35:1207-11. [PMID: 10845836 DOI: 10.1016/s0272-6386(00)70059-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Renal complications of Castleman's disease are uncommon. Among the various renal disorders, including mesangial proliferative glomerulonephritis, membranous glomerulonephritis, and minimal change disease, nephrotic syndrome attributable to renal amyloidosis is very rarely reported. We report a case of mixed type of localized Castleman's disease complicated with nephrotic syndrome. Renal biopsy was performed. The deposition of AA amyloidosis was shown. After the removal of two mesenteric lymphoid masses, the proteinuria was gradually decreased and disappeared. Renal biopsy was repeated after 14 months, and, despite complete remission of nephrotic syndrome, no regression in amyloid deposition was found.
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Affiliation(s)
- K Keven
- Departments of Nephrology and Pathology, Ankara University Medical School, Ibni Sina Hospital, Ankara, Turkey
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23
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Affiliation(s)
- P M Ronco
- Département de Néphrologie and Unité INSERM 489, Hôpital Tenon (Assistance Publique-Hôpitaux de Paris) and Université Pierre et Marie Curie, Paris, France
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