The clinical spectrum of disease severity is very broad, ranging from gradual enlargement of lymph nodes with mild symptoms to sudden, intense onset of symptoms due to life-threatening organ dysfunction caused by elevated cytokines such as interleukin-6 (IL-6). Symptoms of Castleman disease often overlap with symptoms of other more common illnesses. A Castleman disease diagnosis can therefore only be made with a lymph node biopsy that shows characteristic Castleman disease features and when other illnesses have been evaluated and excluded. Patients with UCD have enlarged lymph nodes in one region and mild or no symptoms.
- UCD symptoms can occur secondary to compression of surrounding structures by the enlarged lymph nodes.
- Less commonly, some UCD patients can experience systemic inflammatory symptoms such as fatigue and laboratory abnormalities such as low hemoglobin and elevated C-reactive protein.
Patients with MCD have enlarged lymph nodes in multiple regions of the body and more severe symptoms than in UCD. Signs and symptoms of multicentric Castleman disease (MCD) include:
- Flu-like symptoms: fever, fatigue, weight loss, night sweats, loss of appetite, nausea, and vomiting
- Enlarged lymph nodes
- Enlarged liver or spleen
- Peripheral neuropathy (numbness in the hands and feet)
- Cherry hemangioma skin rash
- Edema (swelling), ascites (fluid accumulation in the abdomen), and/or other symptoms of fluid accumulation
- Kidney dysfunction
- Low albumin
- Anemia (low amount of red blood cells)
- Low or high platelet counts
- Elevated immunoglobulins or gamma globulins