Interleukin-6 Blockade With Tocilizumab In Idiopathic Multicentric Plasma Cell Variant Castleman Disease: Case report

Abstract

Abstract Introduction: Castleman disease represents a group of rare lymphoproliferative disorders with heterogeneous manifestations and similar histopathological features. Due to its broad spectrum of clinical presentations, it can be challenging to reach an accurate diagnosis promptly, thereby delaying adequate treatment for patients. In certain circumstances, demographic and socioeconomic factors influence the treatments patients receive. We aimed to describe the initial response of a patient with idiopathic Multicentric Castleman Disease (iMCD) to treatment with Tocilizumab. Case Presentation: We present the case of a patient with a year-long history of unexplained anemia and, most recently, lymphadenopathy. After a thorough review of systems and extensive workup, a diagnosis of idiopathic multicentric Castleman disease was made. Treatment with tocilizumab, an anti-Interleukin-6 receptor antibody, was initiated due to its availability in countries with limited resources, such as ours. The patient had a rapid favorable clinical response with no signs of relapse. Conclusions: Castleman disease is a lymphoproliferative disorder that should be on our radar when dealing with the differential of a patient with localized or generalized lymphadenopathy. The pathogenesis of iMCD involves hyperproduction of Interleukin 6 (IL-6), and there has been significant progress in its management with monoclonal antibodies, specifically those that involve IL-6 blockade. Anti-IL-6 therapy with tocilizumab can be an option for iMCD treatment, especially in countries where other first-line options are not as readily available.