[Multicentric Castleman's disease accompanied with both lymphoid interstitial pneumonia and interstitial nephritis]

A 60-year old man admitted in November, 1991 because of hyperproteinemia. He had shown a gradual increase in serum levels of gamma-globulin since 1981, and idiopathic plasmacytic lymphadenopathy with hyperimmunoglobulinemia was diagnosed in 1989 when he was admitted to another hospital because of persistent swelling of bilateral inguinal lymph nodes since 1986. Multiple swelling of lymph nodes was observed in the right supraclavicle fossa, the left axillary and bilateral inguinal region, and diffuse reticulo-nodular shadows were observed on his chest roentogenogram. Other laboratory findings were as follows; erythrocyte sedimentation rate 143 mm/hr, CRP 3+, Hb 9.4 g/dl, TP 13.7 g/dl with 69.4% of beta-gamma bridge, BUN 21.1 mg/dl, creatinine 1.6 mg/dl, PaO2 77.6 mmHg, plasma cell count in bone marrow 6.4% and positive tests for autoantibodies such as rheumatoid factor, anti-DNA antibody, anti-smooth muscle antibody, and direct Coombs test. Serum interleukin-6 (IL-6) level increased to 259 pg/ml and IL-1 beta was 39.1 pg/ml. Specimens of both transbronchial lung biopsy and fine-needle kidney biopsy revealed a marked infiltration of lymphocytes and plasma cells into interstitial regions of lung and kidney. We reported here a case of multicentric Castleman's disease (MCD) who also demonstrated lymphoid interstitial pneumonia and interstitial nephritis. The present study suggests that some cytokines including IL-6 and IL-1 beta may be closely related to the pathophysiology of MCD.