Unicentric Castleman Disease With Systemic Symptoms: A Rare Case From Family Practice.

Abdullah A Almalki,Ali Y Al Halbub,Amjad K Aljuaid,Lamis F Aljamaan,Faisal Al-Hawaj,Zoha S Alghamdi,Sarah A Alghamdi,Lamees M Fageeh,Sara A Almagrafi,Khalifah S Alsuqayh,Moayad N Iskandar,Mohammed A Alaamree,Saud G Alosaimi,Saad F Aldaihani,Yahya A Almufarrih

doi:10.7759/cureus.21132

Abstract

Palpable lymphadenopathy is very common in children. The vast majority of cases are due to benign conditions and self-limiting diseases. Careful clinical evaluation, with thorough history taking and make a comprehensive physical examination, is essential to avoid unnecessary invasive procedures and not to misdiagnose possible serious underlying conditions. We report the case of a 9-year-old child with a lump in the right axilla that was first noticed with a swelling two months ago. The lump was not painful but its size has been gradually increasing. The symptom was associated with night sweats. However, there was no history of cough, fever, or weight loss. The child had no history of animal contact or insect bites. No recent travel or history of contact with any sick person was reported. His vaccination schedule was up-to-date. Upon examination, the patient had a smooth non-tender swelling in the right axilla. It measured around 4 x 4 cm. The overlying skin was normal with no erythema or ulceration. The swelling was mobile and was not adherent to the overlying skin. Laboratory investigation showed mild anemia, thrombocytosis, and elevated C-reactive protein level. An ultrasound examination demonstrated a well-circumscribed enlarged lymph node, measuring 3.4 cm in short axis, with an increased blood flow on color doppler. Biopsy findings showed proliferation of the follicular lymphoid tissues that were centered around penetrative vessels giving the appearance of “onion skin” in keeping with Castleman disease. Complete surgical resection of the lymph node was performed and resulted in the resolution of the systemic symptoms. Castleman disease is a rare lymphoproliferative disorder with shared histopathological features. Unicentric Castleman disease usually presents with isolated asymptomatic lymphadenopathy. However, the present case demonstrated that patients with unicentric Castleman disease may exhibit systemic constitutional symptoms similar to that of the multicentric subtype.

Highlights

Palpable lymphadenopathy is a common finding in children
We reported the case of a unicentric Castleman disease in a child presenting with night sweats and axillary lymphadenopathy
We performed a contrast-enhanced computed tomography scan in order to rule out any other lymphadenopathies or pathologies since the patient exhibited systemic symptoms, which is atypical for patients with unicentric Castleman disease [6]

Summary

Introduction

Palpable lymphadenopathy is a common finding in children. It is reported that up to 90% of children may have enlarged lymph nodes due to various etiologies [1]. The child did not complain of joint pain or stiffness and had no skin rash He was evaluated previously by a number of general practitioners who informed the parents that the swelling was. The patient had a history of recurrent acute tonsillitis He underwent tonsillectomy four years ago with no complications. A core-needle biopsy was obtained from the lymph node for histopathological examination It demonstrated proliferation of the follicular lymphoid tissues that were centered around penetrative vessels giving the appearance of “onion skin”. The scan showed re-demonstrated the right axillary lymphadenopathy with no evidence of lymphadenopathy in other regions (Figure 2) These findings represented the diagnosis of unicentric Castleman disease. The arrow shows right axillary lymphadenopathy, with no other enlarged lymph nodes. The patient was followed for one year and had no signs to suggest recurrence

Discussion

Findings

Conclusions

Disclosures