Inferior vena cava thrombosis in a patient with Castleman disease

Introduction: Castleman disease, a lymphoproliferative syndrome, was first described by Benjamin Castleman, as being a rare entity. This disease includes two types: unicentric (UCD – unicentric Castleman disease), in which a single lymph node is affected and multicentric/systemic (MCD – multicentric Castleman disease), in which several lymph nodes are enlarged. The second type is also divided in two subtypes: human herpesvirus 8 associated form, about 50% of cases, and HHV-8 negative form, also known as idiopathic.
Objective: To present a case of inferior vena cava (IVC) partial thrombosis, asymptomatic, in a patient with Castleman disease, treated with immunosuppressive drugs.
Case presentation: We present the case of a male patient, 66 years old, from rural areas, who was diagnosed with MCD HHV-8 negative about a year ago (2017) for which he received Vinblastine, followed by secondary immunodeficiency syndrome. The patient is admitted in the Cardiovascular Rehabilitation Clinic of the Rehabilitation Hospital in Iasi, accusing vertigo, bilateral inferior limbs paresthesia and pain in the right and left hypochondrium, in order to be evaluated both clinically and biologically and to receive adequate treatment. By corroborating clinical with paraclinical data, we found important liver damage (hepatomegaly – 6 cm under coastal rebord, confirmed by ultrasound, accompanied by hepatocytolysis and cholestasis), stage 3 splenomegaly; the paresthesia can be caused by a lumbar spine pathology or by immunosuppressive therapy. Abdominal ultrasound showed partial thrombosis of the IVC, near to the right atrium (RA), thrombus with an antero-posterior diameter of maximum 14mm, extended on a site of about 35 mm, permeable lumen on a site of about 5 mm, permeable suprahepatic veins, normal sized and portal vein (PV) 12 mm, permeable. Cardiac ultrasound confirmed the diagnostic of partial thrombosis of IVC.
Conclusions: IVC thrombosis can be interpreted in the context of Vinblastine therapy, being well known the risk of this kind of disorders associated with immun-suppressive treatment.
The particularity of the case is the lack of symptoms and the accidental discovery of the thrombosis by a routine ultrasound exam.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)