ABSTRACT
A 66 years female, who was since last year under astenia, arthralgias, pimply lesions in spread plates and tests showing eritrosedimentation over 100 mm, anemi, leucocitosis with neutrofilia, policlonal hypergammaglobulinemia, slight proteinuria and IgE on 900. This patient was sporadically treated with corticoids. When made the medical consult had lost 34lb., was under anorexy, as well as dyspepsia. Hemoglobyn 6.9 gr/dl, leucocytes 20000/mm3, neutrofils at 90%, proteinogram the same as former, with hypoalbuminemia. She was taking prednisona, 16 mg/day. When examined showed depress of conscience, astenia, and dermic lesions already quoted. 4 cm nonpainful right axillary adenopaty adhered to deep planes. Medulogram with increased iron, hyperegenerative. Ganglionar biopsia: linfoid hyperplasic process linked to inmune response. Toracoabdominal tomography with adenomegalia in torax and retroperitoneo. Skin biopsia: neutrofilic vasculitis. The patient suspends the 16 mg of prednisona and fever as well as generalized adenopatias come up. After laying aside other ethiologies, and understanding as Castleman Multicentric disease, it is started to supply prednisona 1 mg/kg of weight with a clinical and biochemical fast and outstanding response. After 7 months it was progressively suspended the esteroids and 60 days later, the process fall back; for that, corticoids are restarted, with a good evolution. The illness of Castleman although it is not very frequent, it should be considered as differential diagnosis in those clinical cases that are accompanied with important general commitment, linphadenopaties and respons to steroid therapy.
Mujer de 66 años que un año previo a la consulta presentaba astenia, artralgias, lesiones pruriginosas y eritematosas en placa diseminadas. Eritrosedimentación mayor de 100mm, anemia, leucocitosis con neutrofilia, hipergammaglobulinemia policlonal, proteinuria leve e IgE de 900. Fue tratada esporádicamente con corticoides. Llega a la consulta con pérdida de 15kg de peso, anorexia y dispepsia. Hemoglobina 6.9gr/dl, leucocitos 20000/mm3, neutrófilos 90%, proteinograma similar al previo mas hipoalbuminemia. Recibía prednisona 16mg;día. Al examen bradipsíquica, asténica, lesiones dérmicas ya descritas, adenopatía axilar derecha de 4cm no dolorosa adherida a planos profundos. Medulograma con hierro aumentado, hiperregenerativa. Biopsia ganglionar: proceso hiperplásico linfoide relacionado a respuesta inmune. Tomografía tóracoabdominal con adenomegalias en medias tino y retroperitoneo. Biopsia de piel: vasculitis neutrofílica. Suspende el corticoide y aparece fiebre y adenopatías generalizadas. Tras descartar otras etiologías, se interpreta como Enfermedad de Castleman. Inicia prednisona a lmg/kg/ día con favorable, rápida y llamativa respuesta clínica y bioquímica. Luego de 7 meses se suspende de manera progresiva los esteroides, y a los 60 días presenta recaída por lo que se reinicia la terapéutica con una nueva favorable evolución. La enfermedad de Castleman si bien es poco frecuente, debe ser considerada como diagnóstico diferencial en aquellos cuadros clínicos que se acompañan de importante compromiso general. adenomegalias y respuesta a terapia con corticoides.