Management of a case of Castleman’s disease coexisting with or occurring after transplanted Hodgkin’s lymphoma

Abstract

Castleman’s disease is a benign lymphoproliferative disorder. The coexistence of Hodgkin’s lymphoma and multicentric Castle-man’s disease is a rare phenomenon. We discuss a case of a 48-year-old female patient who had been in the records of the Colentina Hematology Clinic since 2019, with the diagnosis of classic Hodgkin’s Lymphoma, nodular sclerosis type I BNLI, stage IIXB. For this, she underwent 3 courses of ABVD and 2 courses of BEACOPP, without showing complete remission on PET/CT evaluation at the end of treatment. After that, we initiated rescue therapy and performed 4 IGEV courses, followed by autologous stem cell transplantation. For maintenance treatment, we opted for Brentuximab, but it was discontinued after the first administration due to the appearance of adverse reactions. Subsequently, we decided to perform radiotherapy with 20 fractions cumulating a total dose of 36 Gy. Shortly after the radiotherapy, symptoms reappeared which were suspected to be in the context of a relapse of the disease. For confirmatory diagnosis, we performed a new PET-CT which highlighted metabolically active ganglion images. Further, were carried out lymph node biopsy for histopathological and immunohistochemical examinations were carried out. The underlying disease was diagnosed as plasmacytic subtype, HHV8 negative, multicentric Castleman’s disease. For treatment, we relied on administrations of Siltuximab treatment therapy that showed complete remission. Castleman’s disease presents a unique diagnostic challenge, but a confirmatory diagnosis can be based on a biopsy examination, advisable after each relapse.

Keywords

• lymphoid
• hyperplasia
• lymph node
• histopathology
• angio-follicular