Episode 2: Dr. Fajgenbaum’s Commentary


  • After episode 1, patient was discharged and out of hospital for almost 4 weeks
    • Diuresed 42 pounds of fluid and began to feel well again
  • Toward end of 4-weeks, patient started to experience same symptoms he had before first hospitalization:
    • Enlargement of lymph nodes, fatigue and night sweats, and abdominal pain
  • Lab tests performed, as well as CT scan, which found extensive lymphadenopathy throughout the body
  • Lymph node biopsy performed
    • 4 important findings:
      • Regressed germinal centers
      • Plasmacytosis
      • Hyperplastic follicles
      • Extreme vascularization throughout lymph node
  • Multicentric Castleman Disease suspected
  • Additional testing warranted to rule out other disorders
  • No signs of monoclonality within lymph node; other disorders already ruled out
  • Determined to be Multicentric Castleman Disease
  • Tests conducted to determine whether HHV-8—negative or HHV-8–positive Multicentric Castleman Disease
    • Based on negative LANA-1 staining and negative PCR for HHV-8, HHV-8 negative Multicentric Castleman Disease was determined
  • Patient sent back to hospital and started on rituximab
  • Patient did not respond right away
  • Within 48 hours, improvements in laboratory values observed
    • BUN, which peaked over 200, began to improve
    • Creatinine, which was over 2, began to improve
    • CRP, which was over 300 at its peak, started to improve within couple days of starting rituximab
  • Patient achieves partial remission on rituximab and is healthy enough to leave hospital
  • Not yet in complete remission

Read through the episodes of one patient’s journey toward an accurate diagnosis and listen to an expert’s analysis on each episode.

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