Epstein-Barr virus associated multicentric Castleman's disease disguised as infectious mononucleosis

Castleman's disease (CD), also called angiofollicular lymphoid hyperplasia, is a rare lymphoproliferative illness with two unique variants: unicentric disease and multicentric disease (MCD). The multicentric variant is rare and presents as a systemic illness with symptoms like peripheral lymphadenopathy, splenomegaly, anaemia and systemic inflammatory symptoms. Given the vague and systemic presentation, this variant can be difficult to differentiate from infection and other autoimmune diseases. Here, we discuss the case of a middle-aged female who presented to the hospital with a 2 week history of systemic symptoms, including cough, fever, weight loss and painful lymphadenopathy at the neck and posterior auricular region. Initially, the patient was treated for presumed upper respiratory infection in the setting of Epstein-Barr virus (EBV); however, an excisional biopsy of the cervical lymph node confirmed the diagnosis of MCD. In this case, we highlight the diagnostic dilemma of MCD, especially in association with EBV.