Diagnostic pitfall: Castleman’s disease versus systemic lupus erythematosus in a woman with generalised lymphadenopathy

Systemic lupus erythematosus is an autoimmune disease with diverse systemic manifestations, while Castleman disease is a rare lymphoproliferative disorder that often presents with systemic symptoms and can mimic autoimmune disorders. β-thalassaemia trait is a genetic disorder characterised by mild anaemia. We report the case of a young female who presented with febrile episodes persisting for 6 months, accompanied by multiple joint pain and left-sided chest pain for 3 months. Physical examination revealed pallor, generalised lymphadenopathy, splenomegaly and left-sided pleural effusion. Lymph node biopsy initially suggested Castleman disease-hyaline vascular variant. However, further evaluation led to a final diagnosis of systemic lupus erythematosus with lupus nephritis and concomitant β-thalassaemia trait. This case highlights the diagnostic challenge when multiple diseases with overlapping symptoms coexist and the importance of a comprehensive evaluation in patients with atypical presentations to avoid diagnostic overshadowing.