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Cardwell M, Lu MS, Melamed J, Astle J, Gasparri M, Johnstone DW. A Case of Unicentric Castleman Disease with Concomitant Myasthenia Gravis and Persistent Left Superior Vena Cava. Am J Case Rep 2023; 24:e938305. [PMID: 36726305 PMCID: PMC9901491 DOI: 10.12659/ajcr.938305] [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: 01/20/2023] Open
Abstract
BACKGROUND Castleman disease was first described in 1956 as mediastinal masses composed of benign lymphoid hyperplasia with germinal center formation and capillary proliferation closely resembling thymomas. It has been linked with many multi-system disorders, including myasthenia gravis. Cases of Castleman disease with corresponding myasthenia gravis have higher rates of postoperative myasthenic crisis, which are reported as high as 37.5%. We encountered a case of Castleman disease with myasthenia gravis that was discovered early and managed successfully with complete surgical resection and no postoperative myasthenic crisis. CASE REPORT A 25-year-old woman with an uncomplicated history presented with shortness of breath, numbness in hands, tiring with chewing, and fatigue. Myasthenia gravis was diagnosed with serology test results, and a 7.5×7.0-cm mediastinal mass was discovered in addition to the incidental finding of a persistent left superior vena cava, closely abutting the mass. Biopsy showed lymphoid proliferation, regressed germinal centers surrounded by small lymphocytes, and vascular proliferation, consistent with unicentric Castleman disease, hyaline-vascular type. The patient was successfully treated for Castleman disease with myasthenia gravis, and no postoperative myasthenic crisis occurred. CONCLUSIONS Castleman disease associated with myasthenia gravis can dramatically increase the risk of postoperative myasthenic crisis. Our literature review of all 16 cases of Castleman disease with myasthenia gravis since 1973 revealed that 18.75% of cases were associated with a postoperative myasthenic crisis. This association elicits the importance of prompt diagnosis of myasthenia gravis when evaluating mediastinal masses and the value of having neurology and anesthesiology staff aware of the increased risk of crisis.
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Affiliation(s)
- Maxwell Cardwell
- Medical College of Wisconsin, Milwaukee, WI, USA,Corresponding Author: Maxwell Cardwell, e-mail:
| | - Marvin S. Lu
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joshua Melamed
- Medical College of Wisconsin, Milwaukee, WI, USA,Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - John Astle
- Medical College of Wisconsin, Milwaukee, WI, USA,Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mario Gasparri
- Medical College of Wisconsin, Milwaukee, WI, USA,Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - David W. Johnstone
- Medical College of Wisconsin, Milwaukee, WI, USA,Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
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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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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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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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