Dear Satyaprasad

May be a unusual presentation of Castleman's disease

Castleman's disease (AD), also called benign giant linfonodular hyperplasia is a rare entity. In recent years, this disease has been the subject of a great clinical interest because of its association with human immunodeficiency virus (HIV) and human herpesvirus type 8 (HHV - 8). Is associated with a large number of malignancies, including Kaposi's sarcoma, non-Hodgkin's lymphoma, Hodgkin's disease and POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes

This article may be useful for you

BMC Infect Dis. 2003 Sep 11;3:20.

An unusual presentation of Castleman's disease:a case report.

Izuchukwu IS1, Tourbaf K, Mahoney MC.

Dr Vicente will the evaluation by pcr help in any way to identify the cause of lympadenopathy.

As every medical Doctor knows this space is connected to the connective tissue and interstitial space, so that any disorder like infectious diseases or malignancy and even connective tissue disorder can lead to lymphadenopathy. So I think that it is logistic to have a biopsy to rule out any of this differential diagnosis.

Depending on the clinical picture of course. In my limited experience with HIV patients in resource limited settings, retroperitoneal lymphadenopathy was common when we suspected MAC... But as mentioned above, the differential diagnosis is wide.

Dear Satyaprasad, a few years ago we had a patient with retroperitoneal lynphadenopathy, which is dificult to accsess for biopsy; during the physical examination we identifyed a litle mass at the right teticle wich revealed to be a seminomatose tumor. The patient went to surgery and the lynphadenopathy was methetasis of the tumor. patient received quimotherapy and is doin well. I sahre this case with you for we've seen some non-infectious disease missed. Best regards.

Dr Mario thank you for sharing the case.

Many times it has been noted that casual examination may be costly.

Biopsy may be an easy option but the acess and sensitivity of the report isalso to be considered.

To me i would consider biopsy when all history and examnation are well discussed basic investigations done, differential diagnosis discussed, then suggest a biopsy so as to reduce the margin of error by the pathologist. A clinical discussion with the pathologist also will enhance the diagnostic possibilities.

In my opinion, d.d. has to include hematologic conditions as well as other infections like hystoplasmosis. Ultrasound can be helpful: it can add new informations or signs suggestive for HIV associated EPTB. Did the patient have pleuric, pericardial, peritoneal effusion or splenic abscesses? If not, I'd consider US-guided biopsy, and send a sample to the microbiologist as well.

Best regards