Castlemans Disease – Presenting with Recurrent Pleuropericardial Effusions- Mimicking Tuberculosis

Abstract

Castleman disease (CD) is an uncommon heterogeneous group of lymphoproliferative disorders which can affect the lymph nodes of the neck, chest, abdomen and pelvis. It was first described by Castleman, in 1954, known as benign mediastinal lymph node hyperplasia, which was histologically similar to thymoma of unknown cause. [1] It is divided into unicentric (localized ) Castleman disease (UCD) and multicentric ( generalized) Castleman disease (MCD) based on the number of lymph nodes involved. Castleman disease has varied presentations. Clinically it can present as localized masses, or localized lymph node enlargement. Symptoms can result from compression effects of the enlarged lymph nodes and in asymptomatic patients it can be an incidental finding on radiological imaging. It can also present as diffuse lymphadenopathy with severe systemic symptoms . Rarely it presents with pleuro-pericardial effusions . We present a case of a; young gentleman presenting with anorexia, weight loss and night sweats . He had large exudative pleural effusion with pericardial effusion leading to constrictive pericarditis .He was started on ATT empirically, which was later stopped due to poor response . Extensive radiological work revealed multi loculated pleural effusion and multiple lymph nodes in the axillary and cervical area . Excisional Biopsy of the lymph nodes revealed Castleman disease .