A case of idiopathic multicentric Castleman disease in an alemtuzumab-treated patient with MS

(A–E) Charts show the course of CRP, hemoglobin, platelets, white blood cell count, and blood urea nitrogen since the initial presentation during hospitalization. Time points and length of different treatment regimens are outlined in (A) (♦: IV methylprednisolone 250 mg, cumulative dose 2,750 mg; •: immunoadsorption; *: IVIG single dose, 1 mg/kg). Arrows represent platelet (B) and erythrocyte concentrate (C) transfusions and hemodialysis (E). (F) Abdominal CT scan outlining extensive abdominal (red arrows) and inguinal (yellow arrows) lymphadenopathy. (G–H) Axial thoracic and abdominal CT scan indicating polyserositis with pleural (G: yellow arrows) and pericardial (G: red arrows) effusions and ascites (F: yellow arrows) as well as hepatosplenomegaly (F: red arrows). (I) H&E staining of bone marrow puncture displaying megakaryocytosis. (J–K) Mediastinal lymph node biopsy consistent with iMCD plasma cell type. (J) Haematoxylin and eosin stain displaying regressive germinal centers (blue arrows), with small vessels reaching into germinal centers (“lollipop vessels,” black arrows). (K) Giemsa staining displaying interfollicular proliferation of plasma cells (black arrows).