{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T12:03:01Z","timestamp":1789646581658,"version":"4.0.0"},"reference-count":9,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,9,2]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>A man in his early 60s presented initially with abdominal symptoms, nutritional deficiencies, severe hypoalbuminaemia, thrombocytopenia and marked inflammation, without clinically apparent lymphadenopathy. Over subsequent hospitalisations, he developed progressive anasarca, pleural and peritoneal serositis, bicytopenia and renal dysfunction. Cardiac, renal, gastrointestinal, infectious, neoplastic and autoimmune explanations were investigated but did not account for the evolving multisystem picture. Lymphadenopathy became evident only later on positron emission tomography-CT, providing the diagnostic pivot. Lymph node assessment, persistent hyperinflammation and the evolving clinical pattern supported idiopathic multicentric Castleman disease with thrombocytopenia, anasarca, fever\/hyperinflammation, renal dysfunction and organomegaly features (iMCD-TAFRO). Treatment with corticosteroids and siltuximab was followed by clinical and biochemical improvement. This case illustrates how TAFRO syndrome may become recognisable before lymphadenopathy makes Castleman disease an obvious consideration.<\/jats:p>","DOI":"10.1136\/bcr-2026-274330","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T11:25:19Z","timestamp":1789644319000},"page":"e274330","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Evolving idiopathic multicentric Castleman disease with thrombocytopenia, anasarca, fever\/hyperinflammation, renal dysfunction and organomegaly presenting with severe hypoalbuminaemia, serositis and bicytopenia before lymphadenopathy"],"prefix":"10.1136","volume":"19","author":[{"given":"John","family":"Kachope","sequence":"first","affiliation":[{"name":"General Internal Medicine, Misericordia Community Hospital, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Muradov","sequence":"additional","affiliation":[{"name":"General Internal Medicine, Misericordia Community Hospital, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"2026091704251304000_19.9.e274330.1","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1182\/blood.2019000931","article-title":"Overview of Castleman disease","volume":"135","author":"Dispenzieri","year":"2020","journal-title":"Blood"},{"key":"2026091704251304000_19.9.e274330.2","doi-asserted-by":"publisher","DOI":"10.3109\/10428194.2014.953145"},{"key":"2026091704251304000_19.9.e274330.3","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-10-746933"},{"key":"2026091704251304000_19.9.e274330.4","doi-asserted-by":"crossref","DOI":"10.1186\/1752-1947-1-78","article-title":"Multicentric Castleman\u2019s disease: a case report","volume":"1","author":"Menezes","year":"2007","journal-title":"J Med Case Rep"},{"key":"2026091704251304000_19.9.e274330.5","doi-asserted-by":"crossref","first-page":"1626722","DOI":"10.3389\/fmed.2025.1626722","article-title":"Atypical clinical presentation associated with Castleman disease: a case report and review of the literature","volume":"12","author":"Hu","year":"2025","journal-title":"Front Med"},{"key":"2026091704251304000_19.9.e274330.6","doi-asserted-by":"crossref","DOI":"10.1177\/2050313X241240097","article-title":"Successful outcome in a case of idiopathic multicentric Castleman disease with atypical lymphadenopathy and kidney injury: Diagnostic challenges and treatment approach-Case report","volume":"12","author":"Yalikun","year":"2024","journal-title":"SAGE Open Med Case Rep"},{"key":"2026091704251304000_19.9.e274330.7","doi-asserted-by":"crossref","DOI":"10.3390\/diagnostics11040710","article-title":"Renal Diseases Associated with Hematologic Malignancies and Thymoma in the Absence of Renal Monoclonal Immunoglobulin Deposits","volume":"11","author":"Morel","year":"2021","journal-title":"Diagnostics (Basel)"},{"key":"2026091704251304000_19.9.e274330.8","doi-asserted-by":"crossref","unstructured":"James J , Puthiyottil SSV , George J , et al . Castleman Disease: Insights from a Case Series and Literature Review. Indian J Med Paediatr Oncol 2025. doi:10.1055\/s-0045-1810074","DOI":"10.1055\/s-0045-1810074"},{"key":"2026091704251304000_19.9.e274330.9","doi-asserted-by":"crossref","DOI":"10.3389\/pore.2024.1611785","article-title":"Diagnostic challenges in patients with Castleman disease, a single center experience from Hungary","volume":"30","author":"Br\u00fag\u00f3s","year":"2024","journal-title":"Pathol Oncol Res"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-274330","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T11:25:23Z","timestamp":1789644323000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-274330"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":9,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,17]]},"published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1136\/bcr-2026-274330"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-274330","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]}}}