Hu Weiwei, Kong Yuke, Hu Bianxiang, Ai Jun, Zhang Peng
Department of Nephrology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, China.
Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Front Med (Lausanne). 2025 Aug 21;12:1626722. doi: 10.3389/fmed.2025.1626722. eCollection 2025.
Castleman disease (CD) is a group of rare and complicated diseases characterized by systemic inflammation, lymphadenopathy, and multiorgan involvement. It is often misdiagnosed as an infection, an autoimmune disease, or a malignant cancer.
In this case, we report a 33-year-old Chinese male patient who was diagnosed with idiopathic multicentric Castleman disease (iMCD). The patient initially presented with intermittent fever and abdominal pain, followed by the development of abdominal and thoracic cavity effusions, anemia, thrombocytopenia, increased D-dimer levels, and acute kidney injury (AKI). Notably, there was an absence of significant lymphadenopathy in the early stages of disease progression. The final diagnosis was idiopathic multicentric Castleman disease (iMCD).
This case emphasizes the importance of considering iMCD in patients with persistent fever and systemic inflammation, even in the absence of noticeable lymphadenopathy. We should monitor the progression of the disease and adopt a developmental perspective. Different stages of the disease can have different clinical manifestations. Diagnosis requires a comprehensive assessment of clinical, laboratory, and histopathological findings. The rarity and complexity of iMCD can pose diagnostic challenges, especially for healthcare providers who are not familiar with the disease, potentially leading to misdiagnosis. To prevent misdiagnosis, healthcare providers must maintain a high index of suspicion for CD in patients with prolonged fever and no significant lymph node enlargement. Timely recognition and accurate diagnosis are critical for initiating appropriate treatments and improving patient outcomes. Enhancing awareness of iMCD among healthcare providers is essential for early detection and effective management.
卡斯特曼病（CD）是一组罕见且复杂的疾病，其特征为全身炎症、淋巴结病和多器官受累。它常被误诊为感染、自身免疫性疾病或恶性肿瘤。
在本病例中，我们报告了一名33岁的中国男性患者，他被诊断为特发性多中心卡斯特曼病（iMCD）。患者最初表现为间歇性发热和腹痛，随后出现腹腔和胸腔积液、贫血、血小板减少、D-二聚体水平升高以及急性肾损伤（AKI）。值得注意的是，在疾病进展的早期阶段没有明显的淋巴结病。最终诊断为特发性多中心卡斯特曼病（iMCD）。
本病例强调了即使在没有明显淋巴结病的情况下，对于持续发热和全身炎症的患者考虑iMCD的重要性。我们应监测疾病的进展并采取动态的观点。疾病的不同阶段可能有不同的临床表现。诊断需要对临床、实验室和组织病理学检查结果进行全面评估。iMCD的罕见性和复杂性可能带来诊断挑战，尤其是对于不熟悉该疾病的医疗服务提供者，可能导致误诊。为防止误诊，医疗服务提供者必须对长期发热且无明显淋巴结肿大的患者保持高度的怀疑指数。及时识别和准确诊断对于启动适当的治疗和改善患者预后至关重要。提高医疗服务提供者对iMCD的认识对于早期发现和有效管理至关重要。
