SHM Converge Scientific Abstract ePoster Gallery-Unexplained Anasarca, Cytopenias, and Renal Failure: Revisiting Early Clues to Diagnose a Castleman Variant

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This case describes a 38-year-old unhoused man with progressive anasarca, rash, cytopenias, acute kidney injury, and later dialysis-dependent renal failure, massive ascites, and bacteremia. Because his care had been fragmented across multiple states, the initial diagnostic picture was unclear and broad differentials included infection, autoimmune disease, cirrhosis, and systemic inflammatory syndromes.<br /><br />Key findings helped shift suspicion away from isolated organ disease: kidney biopsy showed a membranoproliferative pattern of glomerular injury, suggesting immune-mediated systemic disease; ascitic studies showed a high SAAG with elevated protein, and liver imaging/biopsy demonstrated portal hypertension without cirrhosis, consistent with non-cirrhotic portal hypertension. These clues pointed toward a multisystem inflammatory disorder rather than simple liver or kidney pathology.<br /><br />After extensive evaluation and involvement of more than seven subspecialties, hospitalists advocated for excisional lymph node biopsy. Pathology confirmed idiopathic multicentric Castleman disease (iMCD) with TAFRO features. This syndrome is characterized by thrombocytopenia, anasarca, fever, reticulin fibrosis, and organomegaly, and can present with profound diagnostic uncertainty and multiorgan failure.<br /><br />Treatment with IL-6 blockade and rituximab led to stabilization and improvement in systemic inflammation and organ dysfunction. The case highlights several teaching points: cytopenias with systemic inflammation should prompt evaluation for hematologic and inflammatory causes; membranoproliferative glomerulonephritis is a pattern, not a diagnosis; and portal hypertension without cirrhosis should raise concern for vascular or inflammatory etiologies. Most importantly, it emphasizes the hospitalist’s role in coordinating complex consultative care, maintaining diagnostic momentum, and ensuring continuity for vulnerable patients.

Asset Subtitle

Jack B. Ding

Meta Tag

Author List Jack B. Ding, Lonnie Thach

Category Clinical Vignettes

Concept Idiopathic Multicentric Castleman Disease

Concept TAFRO Syndrome

Concept Anasarca

Concept Cytopenia

Concept Renal Failure

Distinguished Non-Finalist

Presenter Organization Georgetown University and Medstar Washington Hospital Center

Presenting Author Jack B. Ding

Track Adult

Keywords

idiopathic multicentric Castleman disease

TAFRO syndrome

anasarca

membranoproliferative glomerulonephritis

non-cirrhotic portal hypertension

cytopenias

acute kidney injury

dialysis-dependent renal failure

IL-6 blockade

rituximab

Idiopathic Multicentric Castleman Disease

TAFRO Syndrome

Anasarca

Cytopenia

Renal Failure