A rare occurrence of unicentric Castleman disease

Abstract

Castleman disease (CD) is a rare lymphoproliferative disorder characterized by enlarged lymph nodes involving the neck, mediastinum, and retroperitoneum. Due to its varied presentations, it is often misdiagnosed or underdiagnosed. We present one such case which posed a great diagnostic challenge. An 18-year-old girl presented with fever on and off for 1 year. She was treated for COVID positivity during this time but had persistent evening rise of temperature even after 21 days of COVID negativity. Computed tomography chest done revealed a posterior mediastinal mass on the right side. Biopsy showed features of granulomatous inflammation. She was subsequently started on anti-tuberculous therapy. Repeat imaging showed no significant interval change in the mass and biopsy showed features of cavernous hemangioma. She underwent right posterolateral thoracotomy and excision of posterior mediastinal mass. Histopathology of the mass revealed it to be a hyaline variant of CD. CD is rare in children and the presentation can be very atypical and non-specific. They can be misdiagnosed as various other conditions. In most cases, it is an unanticipated pathological diagnosis.