title: Renal involvement in multicentric Castleman disease with glomeruloid hemangioma of skin and plasmacytoma.
abstract: A 47-year-old man presented with fever of unknown origin, generalized weakness, edema, and renal failure. He had left-sided pleural effusion, generalized lymphadenopathy, multiple nontender cutaneous nodules, hepatomegaly, renal failure, and hypergammaglobulinemia. Axillary lymph node biopsy showed findings consistent with Castleman disease of the hyaline vascular type associated with interfollicular plasmacytosis. A renal biopsy performed in view of proteinuria and acute renal failure showed hypercellular glomeruli with capillary loop thickening and double contours consistent with membranoproliferative glomerulonephritis. Skin nodule biopsy showed a glomeruloid hemangioma characterized by dermal proliferation of capillary loops in a nodular manner resembling a glomerulus. He experienced clinical and biochemical remission with steroids. Discontinuation of steroid therapy was associated with recurrence of renal failure, reappearance of nodules, lymphadenopathy, and appearance of bony lytic lesions. Biopsy of bony lytic lesions showed plasmacytoma. The patient achieved complete remission on treatment with steroids and cyclophosphamide and is free of symptoms at the end of 40 months of follow-up. To our knowledge, this is the first case report of the occurrence of membranoproliferative glomerulonephritis, glomeruloid hemangioma of the skin, and plasmacytoma in a patient with multicentric Castleman disease without human immunodeficiency virus infection.
authors.affiliation: Department of Nephrology, Medical College Thiruvananthapuram, Kerala, India. susanuthup@yahoo.co.uk
authors.forename: Susan
authors.initials: S
authors.lastname: Uthup
authors.forename: Krishna
authors.initials: K
authors.lastname: Balachandran
authors.forename: Vimala Avadai
authors.initials: VA
authors.lastname: Ammal
authors.forename: Riyas
authors.initials: R
authors.lastname: Abdul Salam
authors.forename: Jacob
authors.initials: J
authors.lastname: George
authors.forename: Geetha M
authors.initials: GM
authors.lastname: Nair
authors.forename: Manju
authors.initials: M
authors.lastname: Leela
mesh_terms: D001706:Biopsy; D005871:Castleman Disease / Q000150:complications* / Q000188:drug therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D015432:Glomerulonephritis, Membranoproliferative / Q000209:etiology*; D006391:Hemangioma / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010954:Plasmacytoma / Q000209:etiology* / Q000473:pathology; D012878:Skin Neoplasms / Q000209:etiology* / Q000473:pathology; D013256:Steroids / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids; D003520:Cyclophosphamide