2012 Volume 122 Issue 6 Pages 1571-1579
A 42-year-old man was diagnosed with multicentric Castleman’s disease at the age of 32 years. Laboratory data indicated polyclonal hyper-γglobulinemia, anemia, and elevated levels of C-reactive protein, erythrocyte sedimentation rate, and IL-6. A skin biopsy revealed the formation of many lymphoid follicles and lymphoplasmacytic infiltration cells in the dermis. No gene rearrangement was detected from the skin biopsy using both Southern blotting and PCR analysis techniques. A chest CT revealed a bilateral, peripheral, finely granular appearance, bilateral lymphadenopathy in the axilla and mediastinum, and paratracheal lesions. The patient was diagnosed with multicentric Castleman’s disease and treated with predonisolone and cyclophosphamide, but the clinical symptoms gradually progressed. Tocilizumab, an anti IL-6 receptor antibody, was administered every 2 weeks when the patient was 38 years old, and his clinical condition and laboratory data improved. Two years and 8 months later, the patient was found to have cervical lymphadenopathy, and, six months after that, a lymph node biopsy led to a diagnosis of mixed cellularity Hodgkin lymphoma. The administration of tocilizumab was suspended, and chemotherapy was given, resulting in complete remission. It has been reported that there is a significant incidence of malignant lymphoma in Castleman’s disease. Conversely, tocilizumab is apparently effective for Castleman’s disease when the patient presents with systemic symptoms. The relationship between tocilizumab and malignant lymphoma remains obscure. We examined the problem of administration of tocilizumab in Castleman’s disease.
