Castleman Disease Versus Generalized Tuberculosis: A Case of Fever of Unknown Origin

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis; it has a high prevalence in developing countries such as Peru. Although its most frequent clinical presentation is pulmonary, but it can damage any organ and have multisystem clinical manifestations. The gold standard for its diagnosis is the finding of the bacteria in the culture; however, the result of the same can take several weeks. We present the case of a 25 year old female patient with no significant clinical history, who was admitted due to various symptoms and signs, which was classified as fever of unknown origin after several weeks of studies and inconclusive test results. She presented multisystem involvement: lymph nodes, hepatic, gastrointestinal, hematological, pleural, and pulmonary. A biopsy of cervical lymphadenopathy was performed, and the pathology report was conclusive with Hyaline vascular variant Castleman's disease; however, the gastric aspirate culture study was positive for tuberculosis. A bibliographic search was carried out on the relationship between these two entities, finding that the diagnosis of tuberculosis rules out Castleman's disease. The patient received tuberculosis treatment for 6 months, with which she presented progressive improvement of clinical manifestations. In developing patients, it is important to consider that infectious diseases such as tuberculosis can have a very varied clinical presentation and multisystem involvement, which is why they should always be considered before other more rare ones.