Mercyhealth Gastroenterology Fellowship Rockford, IL
Abu Fahad Abbasi, MD1, Luqman Baloch, MD1, Fahad Mehmood, MD2, Sultan Ahmed, DO3, Ammar Aqeel, MD4, Kyoko Misawa, MD4, Abdul Mubeen Khan, MD1, Naser Khan, MD5, Baseer Qazi, MD5, Altaf Dawood, MD5, Thayer Hamoudah, MD5 1Mercyhealth Gastroenterology Fellowship, Rockford, IL; 2Mercy Health, Rockford, IL; 3Mercyhealth Internal Medicine Residency, Rockford, IL; 4Mercyhealth, Rockford, IL; 5Mercyhealth Gastroenterology, Rockford, IL Introduction: Castleman's disease (CD) is a heterogeneous group of rare lymphoproliferative disorders, with unicentric or multicentric involvement. Multicentric Castleman's disease (MCD), associated with elevated interleukin-6 (IL-6), is characterized by systemic symptoms and widespread lymphadenopathy. Ascites in MCD is rare and typically linked to lymphatic obstruction or increased vascular permeability. Portal hypertension secondary to cirrhosis in MCD patients without classic risk factors is exceedingly uncommon.
Case Description/
Methods: A 47-year-old female with MCD (on siltuximab), chronic kidney disease stage 3B, and hypothyroidism presented with worsening abdominal distention and pain. She had previously undergone PleurX catheter placement for recurrent ascites, which was removed due to Serratia peritonitis. On presentation, she was afebrile and hemodynamically stable. Labs showed stable liver enzymes, normal INR, and platelet count >150,000/μL. Ascitic fluid analysis revealed a serum-ascites albumin gradient (SAAG) >1.1 g/dL and total protein < 2.5 g/dL, consistent with portal hypertension. CT imaging showed ascites, borderline hepatomegaly, and subtle liver nodularity concerning for cirrhosis. Liver Doppler ultrasound was unremarkable. She denied alcohol use, intravenous drug use, and had no known viral hepatitis exposure. Previous endoscopies showed no varices or signs of chronic liver disease. No clinical stigmata of liver dysfunction had been noted. Discussion: Ascites in MCD is uncommon and usually secondary to lymphatic obstruction or cytokine-mediated increased vascular permeability. In this case, recurrent ascites with imaging and fluid analysis suggested portal hypertension. The absence of classic risk factors such as alcohol, viral hepatitis, or metabolic liver disease makes this presentation rare. Cirrhosis in MCD has been rarely reported. Prior cases by Abarca et al. and Takai et al. have described portal hypertension without established cirrhosis, suggesting immune-mediated or cytokine-induced hepatic changes. Although siltuximab has not been definitively linked to liver fibrosis, data are limited. We present a rare case of presumed cirrhosis and portal hypertension in a patient with MCD. This underscores the need to consider hepatic involvement in MCD patients with unexplained ascites and suggests the value of longitudinal hepatic monitoring in this population.
Disclosures: Abu Fahad Abbasi indicated no relevant financial relationships. Luqman Baloch indicated no relevant financial relationships. Fahad Mehmood indicated no relevant financial relationships. Sultan Ahmed indicated no relevant financial relationships. Ammar Aqeel indicated no relevant financial relationships. Kyoko Misawa indicated no relevant financial relationships. Abdul Mubeen Khan indicated no relevant financial relationships. Naser Khan indicated no relevant financial relationships. Baseer Qazi indicated no relevant financial relationships. Altaf Dawood indicated no relevant financial relationships. Thayer Hamoudah indicated no relevant financial relationships.
Abu Fahad Abbasi, MD1, Luqman Baloch, MD1, Fahad Mehmood, MD2, Sultan Ahmed, DO3, Ammar Aqeel, MD4, Kyoko Misawa, MD4, Abdul Mubeen Khan, MD1, Naser Khan, MD5, Baseer Qazi, MD5, Altaf Dawood, MD5, Thayer Hamoudah, MD5. P6080 - Multicentric Castleman’s Disease: An Unusual Culprit for Portal Hypertension, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
