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The 50‐year‐old‐patient presented with exuberant multisystem inflammation. With a history of MIS‐A, a relapse was initially considered; however, there are no documented cases of relapsed MIS‐A. Thus, alternative causes were considered, especially in the context of extensive lymphadenopathy.

Core lymph node biopsy results revealed non‐caseating granulomas, initially suspicious of sarcoidosis. However, non‐caseating granulomas may also indicate many viral, bacterial or fungal infections, vasculitides, occupational diseases and haematological disorders. Core lymph node biopsies can provide definitive diagnosis in more than 92% of cases. However, they have an increased rate of incorrect and non‐conclusive diagnosis compared to an excisional lymph node biopsy. Excisional lymph node biopsies should be pursued if any diagnostic ambiguity exists. In this case, excisional lymph node biopsy results led to our diagnosis of Castleman disease.

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Authors: Katherine J Punshon and Anugrah Chrispal

Article Type: Medical Education