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A 32-year-old woman presented with mild fever and solitary discrete cervical lymph node (5 cm) for 2 years. The excision biopsy showed preserved lymph-node architecture with prominent onion skinning (figure 1) and hyalinised blood vessels in the germinal centres (figure 1, inset). The patient was investigated thoroughly for lymph nodes else where, but no lymph nodes could be detected. The overall picture was suggestive of localised Castleman disease (LCD), hyaline vascular type. The HIV, HHV-8 and Epstein Barr Virus serology was negative.
The patient returned 5 years later with abdominal distension, weight loss, cervical and inguinal lymphadenopathy, hepatoslenomegaly and vescicobullous skin rashes for 3 months. CT and MRI revealed multiple cervical, retroperitoneal and mediastinal lymph nodes (figure 2). …