Idiopathic Multicentric Castleman Disease with Autoimmune Hemolytic Anemia and Production of Anti-drug Antibody against Tocilizumab

Intern Med. 2019 Nov 15;58(22):3313-3318. doi: 10.2169/internalmedicine.2989-19. Epub 2019 Jul 10.

Abstract

Idiopathic multicentric Castleman disease (iMCD) is a rare lymphoproliferative disorder, and only a few cases have been reported to be complicated with autoimmune hemolytic anemia (AIHA). A 43-year-old man who presented with multiple swollen lymph nodes was diagnosed with iMCD. He was also diagnosed with AIHA based on laboratory findings, including the results of a bone marrow aspiration study. The patient was treated with tocilizumab; however, the effect was limited, probably due to anti-drug antibodies. Tocilizumab was therefore switched to rituximab, and his anemia was improved. Complication with AIHA should be carefully considered when iMCD patients present with severe anemia.

Keywords: anti-drug antibody; autoimmune hemolytic anemia; multicentric Castleman disease; tocilizumab.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anemia, Hemolytic, Autoimmune / complications*
  • Anemia, Hemolytic, Autoimmune / diagnosis
  • Anemia, Hemolytic, Autoimmune / drug therapy
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Antineoplastic Agents, Immunological / therapeutic use
  • Castleman Disease / complications*
  • Humans
  • Male
  • Rituximab / therapeutic use

Substances

  • Antibodies, Monoclonal, Humanized
  • Antineoplastic Agents, Immunological
  • Rituximab
  • tocilizumab

Supplementary concepts

  • Multi-centric Castleman's Disease