A rare case of Castleman disease presented with diffuse ground glass nodules in both lungs: Case report.

Abstract

Rationale: Castleman disease (CD) is a rare chronic lymphoproliferative disorder with unclear etiology and pathogenesis. It is divided into unicentric CD, which involved a single enlarged lymph node or region of lymph nodes, and multicentric CD, which involved multiple lymph node stations. Chest computed tomography (CT) scan is of great value in the diagnosis and differential diagnosis of the disease. CT scan mainly present large soft tissue mass in lungs and multiple mediastinal lymph node enlargement. Multiple ground glass nodules in both lungs are rare in CD patient.

Patient concerns: A 48-year-old woman presented with chest tightness, shortness of breath, cough, and sputum. The chest CT scan showed multiple ground glass nodules in both lungs.

Diagnoses: Multicentric Castleman disease was diagnosed through biopsies of the mediastinal 4R group, 7th group lymph nodes and the right inguinal lymph nodes.

Interventions: Initial treatment with prednisone was administered, but due to the absence of significant radiological improvement on chest CT after 1 month, a systemic chemotherapy was initiated.

Outcomes: After 6 cycles of systemic chemotherapy with cyclophosphamide, vincristine, and prednisone, the patient chest CT and clinical symptoms improved. Currently, the patient is still receiving low-dose prednisone and cyclophosphamide orally for long-term maintenance treatment.

Lessons: CD that presents multiple ground glass nodules in both lungs is rare. It is easily confused with other diseases, identified diagnosis is depend on pathological examination. The accuracy of clinical subtype and histopathogenic type are important for treatment and outcome.