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His liver biopsy showed non-specific inflammatory changes. His bone marrow biopsy showed megakaryocyte hyperplasia and fibrosis, which raised suspicion for the thrombocytopenia, ascites, reticulin fibrosis, renal dysfunction and organomegaly syndrome subtype of multicentric Castleman disease. This prompted a repeat lymph node biopsy, showing changes consistent with mixed type Castleman disease that fit with his clinical picture. He was initiated on steroids and siltuximab with significant clinical improvement.<\/jats:p>","DOI":"10.1136\/bcr-2020-236654","type":"journal-article","created":{"date-parts":[[2020,11,23]],"date-time":"2020-11-23T16:14:29Z","timestamp":1606148069000},"page":"e236654","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Five biopsies, one diagnosis: challenges in idiopathic multicentric Castleman disease"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2933-2741","authenticated-orcid":false,"given":"Julie","family":"Semenchuk","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asad","family":"Merchant","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Nephrology, University of Toronto, Toronto, Ontario, 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