Systemic lupus erythematosus and Castleman's disease

Area of Science:

• Immunology
• Oncology
• Pathology

Background:

• Systemic lupus erythematosus (SLE) commonly presents with lymphadenopathy, which typically resolves with glucocorticoid treatment.
• Lymphoid malignancies are rare complications in SLE patients.
• Progressive lymphadenopathy despite aggressive SLE treatment necessitates further investigation.

Observation:

• A patient with SLE and thrombocytopenia exhibited progressive lymphadenopathy unresponsive to high-dose corticosteroids.
• Initial histopathology indicated aggressive plasmacytosis, a feature of Castleman's disease (CD).

Findings:

• Castleman's disease (angiofollicular hyperplasia) is a rare lymphoproliferative neoplasm.
• CD shares overlapping features with various autoimmune diseases.
• The patient's presentation highlighted the diagnostic challenge posed by CD in the context of SLE.

Implications:

• Castleman's disease should be considered in the differential diagnosis of autoimmune diseases presenting with unremitting or progressive lymphadenopathy.
• This case underscores the importance of considering rare lymphoproliferative disorders in patients with refractory symptoms.
• Accurate diagnosis is crucial for appropriate management, distinguishing CD from SLE flares or lymphoid malignancies.