PMC7502372_01
(a) One month before admission. The chest X-ray showed diffuse ground-glass opacity and reticular shadows in the lower area of both lungs. (b) Four weeks after starting steroid therapy. Lung lesions have improved.
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The chest X-ray showed diffuse ground-glass opacity (GGO) (Fig. 1a). Chest images one month later showed improvement (Figs. 1b and 2d).
(a) One month before admission. The chest CT scan showed diffuse ground-glass opacity and interlobular septal thickening in the inferior lobe, presenting a nonspecific interstitial pneumonia pattern. (b) Mediastinum lymphadenopathy can also be seen. (c) On admission. Lung lesions have advanced. (d) Four weeks after starting steroid therapy. Lung lesions have improved.
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The chest CT scan revealed diffuse interstitial lung disease consisting of GGO, patterned NSIP (Fig. 2a), and pulmonary function test proved the decline of vital capacity. The chest CT scan showed that ground-glass opacities had progressed in one month (Fig. 2c). Also, multiple mediastinal lymph nodes enlargements were found (Fig. 2b), and laboratory tests revealed increased interleukin-6 (Table). Chest images one month later showed improvement (Figs. 1b and 2d).
Pathological findings of the mediastinum lymph node. (a) High magnification view. Atrophic germinal center with proliferating sclerotic blood vessels (hyaline vascular variant). (b) Plasma cells proliferate in interfollicle (plasma cell variant).
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Thoracoscopic lung and mediastinal lymph node biopsies were performed, and pathologic findings of the lymph node suggested Castleman disease of mixed hyaline vascular and plasma cell variant (Fig. 3).
(a) Pathological findings of the lung revealed plasma cell infiltration in the interlobular septa and interalveolar septum with a thickening. Lymphoid follicles were shown around the bronchiole. (b) Elastica van Gieson stain showing the fibrous thickening of the interstitium and collapse of alveoli.
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Pathological findings of the lung showed that the fibrous thickening of interstitium with plasma cells infiltration and the collapse of alveoli (Fig. 4).