Managing Relapsed Castleman Disease: A Case Report on Integrative Treatment with Rituximab, R-CHOP, and Tocilizumab

Abstract Castleman disease (CD) is a rare lymphoproliferative disorder characterized by excessive proliferation of lymphoid tissues. This case report describes the management of relapsed CD in a 68-year-old woman who presented with generalized weakness, tiredness, loss of appetite, and intermittent breathing difficulty. The patient had a history of diabetes mellitus, and the initial evaluation revealed anemia, albumin/globulin ratio reversal, hepatomegaly, and splenomegaly. Bone marrow analysis and biopsy confirmed the diagnosis of CD, and positron emission tomography–computed tomography revealed increased fluorodeoxyglucose uptake at various lymph node stations. The patient was initially treated with rituximab and prednisolone, followed by six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone chemotherapy. Despite the initial treatment success, the patient experienced relapse two months later. Tocilizumab, an IL-6 receptor antagonist, was added to the treatment regimen, and the patient was advised to continue supportive care. The patient showed symptomatic improvement after treatment, and regular follow-up visits were scheduled to monitor potential complications and manage emerging symptoms. This case highlights the complexity of managing relapsed CD and emphasizes the importance of a multidisciplinary approach involving rheumatologists, oncologists, and other specialists. The successful management of relapsed CD in this case underscores the need for personalized treatment strategies and adaptable treatment protocols in various clinical settings.