Abstract
The patient was a 73-year-old woman who had been administered tocilizmab for multicentric Castleman's disease for about 10 years that led to a favorable control of the disease. She was pointed out having esophageal cancer at a medical checkup and was referred to our hospital for surgery. We performed thoracoscopic-assisted subtotal esophagectomy 19 days after the final day of tocilizumab regimen. She left the intensive care ward on the first postoperative day (POD), started to walk on the second POD, and resumed oral intake on the 14th POD. Few episodes of high fever or increases in CRP level occurred after the second POD. Although the CRP level tended to be elevated since the 17th POD, no findings suggestive of postoperative complications were seen. Administration of tocilizmab was resumed on the 22nd POD and she was discharged on independent gait on the 28th POD. During the tocilizmab withdrawal period employed in this case, the CRP level was scarcely elevated on blood analysis, even though it was analyzed immediately after the surgery. A possibility that the CRP level cannot be a determinant index of infectious postoperative complication appears to arise. We could safely resume administration of tocilizmab for the patient with Castleman's disease whose CRP level was elevated probably due to worsening of the disease after the surgery.
