Castleman-like presentation of systemic lupus: About a case report

• Published in: La revue de medecine interne Vol. 44; no. 2; pp. 85 - 88
• Main Authors: Ferreira De Matos, C, De Almeida Chaves, S, Potin, P, Syrykh, C, Piel-Julian, M-L, Sailler, L, Moulis, G
• Format: Journal Article
• Language: English; French
• Published: France 01.02.2023
• Subjects: Adrenal Cortex Hormones - therapeutic use; Castleman Disease - complications; Castleman Disease - diagnosis; Castleman Disease - drug therapy; Female; Humans; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - diagnosis; Middle Aged; Positron Emission Tomography Computed Tomography; Symptom Flare Up; Lupus systémique; Maladie de Castleman; Castleman disease; Systemic lupus
• ISSN: 1768-3122
• DOI: 10.1016/j.revmed.2022.08.006

Castleman disease is a rare lymphoproliferation, which may mimic systemic lupus. Conversely, systemic lupus sometimes presents like an hematological malignancy. In these cases, a "Castleman-like" histology has been exceptionally described. A 55-year-old female treated by methotrexate for systemic lupus with skin and joint involvement presented weight loss, polyadenopathy and clinical signs of lupus flare. Biology showed pancytopenia, complement activation, and positive anti-DNA antibodies. PET/CT showed hypermetabolic polyadenopathy. The lymph node biopsy showed "Castleman-like" features. Treatment with corticosteroids and azathioprine resulted in complete remission. Systemic lupus and Castleman disease may share common clinical, biological, and histological features. The presence of specific elements of systemic lupus flare and the remission obtained by low-dose corticosteroids results in considering the diagnosis of Castleman-like systemic lupus and avoiding treatment intensification.