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- Kohei Shiroshita, Taku Kikuchi, Mikio Okayama, Hidenori Kasahara, Takahiro Kamiya, Takayuki Shimizu, Nozomu Kurose, Yasufumi Masaki, and Shinichiro Okamoto.
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan.
- Intern. Med. 2020 Dec 1; 59 (23): 3061-3065.
AbstractAn inguinal lymph node biopsy of a woman with a one-month history of a progressive fever, fatigue, dyspnea, skin rash, and lymphadenopathy revealed a well-preserved basic structure, hyperplastic germinal centers, and an interfollicular region containing polyclonal plasma cell sheets, suggesting plasma cell-type multicentric Castleman disease (MCD). We initiated prednisolone and anti-interleukin (IL)-6 antibody (tocilizumab), without success. A biopsy specimen re-evaluation detected CD20-positive atypical large B cells infiltrating the small vessels within and around the lymph node and its capsule. We diagnosed her with intravascular large B-cell lymphoma (IVLBCL). Lymphoma cells were weakly positive for IL-6 by immunohistochemical staining. IL-6 from lymphoma cells may have caused the MCD-like presentation as a paraneoplastic etiology. Malignant lymphoma should be excluded before diagnosing MCD.
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