Multicentric Castleman Disease with Monoclonal Incomplete IgH Restriction

A Rare Coexistence

Gaurav Goyal, Kayla Kendric, Peter T. Silberstein, Gabriel C. Caponetti, Renuga Vivekanandan

Research output: Contribution to journalArticle

Abstract

Castleman disease is a rare lymphoproliferative disorder that may have a unicentric or multicentric clinical presentation. Herein we present the case of a 49-year-old female with a 3-year history of progressively worsening lymphadenopathy associated with fevers, chills and night sweats. Laboratory studies showed anemia and mildly elevated sedimentation rate. A computed tomogram scan of the chest, abdomen and pelvis showed multiple enlarged bilateral axillary, supraclavicular, subpectoral, submental, retroperitoneal, and para-aortic lymph nodes. A right axillary lymph node biopsy was performed and found to display histopathologic features compatible with the plasma cell type of Castleman disease. The patient was found to be human immunodeficiency virus (HIV)-positive, with a viral load of 104,000/mL and a CD4 cell count of 84 cells/mm(3). Molecular studies on the lymph node specimen revealed an incomplete monoclonal DH-JH rearrangement in the IgH gene. The patient was initially treated with antiretroviral therapy with a combination of elvitegravir, cobicistat, emtricitabine and tenofovir that improved her fatigue and malaise. As treatment for Castleman disease, she was administered a combination of rituximab and etoposide, which led to a reduction in lymphadenopathy. To the best of the authors' knowledge, this is the first reported case of multicentric Castleman disease with monoclonal incomplete IgH gene rearrangement in an HIV-positive patient.

Original languageEnglish (US)
Pages (from-to)103-108
Number of pages6
JournalJournal of clinical and experimental hematopathology : JCEH
Volume55
Issue number2
DOIs
StatePublished - 2015

Fingerprint

Giant Lymph Node Hyperplasia
Tenofovir
Lymph Nodes
HIV
Chills
Lymphoproliferative Disorders
Sweat
Gene Rearrangement
Etoposide
CD4 Lymphocyte Count
Plasma Cells
Viral Load
Pelvis
Abdomen
Fatigue
Anemia
Fever
Thorax
Biopsy
Therapeutics

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Multicentric Castleman Disease with Monoclonal Incomplete IgH Restriction : A Rare Coexistence. / Goyal, Gaurav; Kendric, Kayla; Silberstein, Peter T.; Caponetti, Gabriel C.; Vivekanandan, Renuga.

In: Journal of clinical and experimental hematopathology : JCEH, Vol. 55, No. 2, 2015, p. 103-108.

Research output: Contribution to journalArticle

Goyal, Gaurav ; Kendric, Kayla ; Silberstein, Peter T. ; Caponetti, Gabriel C. ; Vivekanandan, Renuga. / Multicentric Castleman Disease with Monoclonal Incomplete IgH Restriction : A Rare Coexistence. In: Journal of clinical and experimental hematopathology : JCEH. 2015 ; Vol. 55, No. 2. pp. 103-108.
@article{961843e04bc4434596a37631a03f52e4,
title = "Multicentric Castleman Disease with Monoclonal Incomplete IgH Restriction: A Rare Coexistence",
abstract = "Castleman disease is a rare lymphoproliferative disorder that may have a unicentric or multicentric clinical presentation. Herein we present the case of a 49-year-old female with a 3-year history of progressively worsening lymphadenopathy associated with fevers, chills and night sweats. Laboratory studies showed anemia and mildly elevated sedimentation rate. A computed tomogram scan of the chest, abdomen and pelvis showed multiple enlarged bilateral axillary, supraclavicular, subpectoral, submental, retroperitoneal, and para-aortic lymph nodes. A right axillary lymph node biopsy was performed and found to display histopathologic features compatible with the plasma cell type of Castleman disease. The patient was found to be human immunodeficiency virus (HIV)-positive, with a viral load of 104,000/mL and a CD4 cell count of 84 cells/mm(3). Molecular studies on the lymph node specimen revealed an incomplete monoclonal DH-JH rearrangement in the IgH gene. The patient was initially treated with antiretroviral therapy with a combination of elvitegravir, cobicistat, emtricitabine and tenofovir that improved her fatigue and malaise. As treatment for Castleman disease, she was administered a combination of rituximab and etoposide, which led to a reduction in lymphadenopathy. To the best of the authors' knowledge, this is the first reported case of multicentric Castleman disease with monoclonal incomplete IgH gene rearrangement in an HIV-positive patient.",
author = "Gaurav Goyal and Kayla Kendric and Silberstein, {Peter T.} and Caponetti, {Gabriel C.} and Renuga Vivekanandan",
year = "2015",
doi = "10.3960/jslrt.55.103",
language = "English (US)",
volume = "55",
pages = "103--108",
journal = "Journal of clinical and experimental hematopathology : JCEH",
issn = "1346-4280",
publisher = "Nihon Rinpa Monaikei Gakkai",
number = "2",

}

TY - JOUR

T1 - Multicentric Castleman Disease with Monoclonal Incomplete IgH Restriction

T2 - A Rare Coexistence

AU - Goyal, Gaurav

AU - Kendric, Kayla

AU - Silberstein, Peter T.

AU - Caponetti, Gabriel C.

AU - Vivekanandan, Renuga

PY - 2015

Y1 - 2015

N2 - Castleman disease is a rare lymphoproliferative disorder that may have a unicentric or multicentric clinical presentation. Herein we present the case of a 49-year-old female with a 3-year history of progressively worsening lymphadenopathy associated with fevers, chills and night sweats. Laboratory studies showed anemia and mildly elevated sedimentation rate. A computed tomogram scan of the chest, abdomen and pelvis showed multiple enlarged bilateral axillary, supraclavicular, subpectoral, submental, retroperitoneal, and para-aortic lymph nodes. A right axillary lymph node biopsy was performed and found to display histopathologic features compatible with the plasma cell type of Castleman disease. The patient was found to be human immunodeficiency virus (HIV)-positive, with a viral load of 104,000/mL and a CD4 cell count of 84 cells/mm(3). Molecular studies on the lymph node specimen revealed an incomplete monoclonal DH-JH rearrangement in the IgH gene. The patient was initially treated with antiretroviral therapy with a combination of elvitegravir, cobicistat, emtricitabine and tenofovir that improved her fatigue and malaise. As treatment for Castleman disease, she was administered a combination of rituximab and etoposide, which led to a reduction in lymphadenopathy. To the best of the authors' knowledge, this is the first reported case of multicentric Castleman disease with monoclonal incomplete IgH gene rearrangement in an HIV-positive patient.

AB - Castleman disease is a rare lymphoproliferative disorder that may have a unicentric or multicentric clinical presentation. Herein we present the case of a 49-year-old female with a 3-year history of progressively worsening lymphadenopathy associated with fevers, chills and night sweats. Laboratory studies showed anemia and mildly elevated sedimentation rate. A computed tomogram scan of the chest, abdomen and pelvis showed multiple enlarged bilateral axillary, supraclavicular, subpectoral, submental, retroperitoneal, and para-aortic lymph nodes. A right axillary lymph node biopsy was performed and found to display histopathologic features compatible with the plasma cell type of Castleman disease. The patient was found to be human immunodeficiency virus (HIV)-positive, with a viral load of 104,000/mL and a CD4 cell count of 84 cells/mm(3). Molecular studies on the lymph node specimen revealed an incomplete monoclonal DH-JH rearrangement in the IgH gene. The patient was initially treated with antiretroviral therapy with a combination of elvitegravir, cobicistat, emtricitabine and tenofovir that improved her fatigue and malaise. As treatment for Castleman disease, she was administered a combination of rituximab and etoposide, which led to a reduction in lymphadenopathy. To the best of the authors' knowledge, this is the first reported case of multicentric Castleman disease with monoclonal incomplete IgH gene rearrangement in an HIV-positive patient.

UR - http://www.scopus.com/inward/record.url?scp=84979993362&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84979993362&partnerID=8YFLogxK

U2 - 10.3960/jslrt.55.103

DO - 10.3960/jslrt.55.103

M3 - Article

VL - 55

SP - 103

EP - 108

JO - Journal of clinical and experimental hematopathology : JCEH

JF - Journal of clinical and experimental hematopathology : JCEH

SN - 1346-4280

IS - 2

ER -