Patient returns to ER with persistent cough, odynophagia and nausea.
Physical exam reveals low grade temperature, tachypnea, hypoxia and patient in respiratory distress.
Chest x ray shows mediastinal widening and cat scan reveals a 2cm left hilar mass with multiple mediastinal lymph nodes. Transthoracic biopsy reveals angiofollicular hyperplasia also known as Castleman's disease. Castleman's disease was first described by Frank Castleman in a group of patients with localized mediastinal lymph node enlargement. It has 2 histologic types including the hyaline vascular and the plasma cell variant. The plasma cell type is often found in patients with multicentric disease which presents as a systemic illness with disseminated lymphadenopathy.