Hepatic sinusoidal dilatation associated to giant lymph node hyperplasia (Castleman's) : A new case in a patient with periorbital xanthelasmas and history of celiac disease

We present a new case of hepatic sinusoidal dilatation associated to giant lymph node hyperplasia or Castleman's disease in a 23-year-old patient with xanthelasmas and history of celiac disease. He presented with weight loss, hepatomegaly, periorbital xanthomas, anemia, accelerated erythrosedimentation rate, hypoalbuminemia, hypergammaglobulinemia at the expense of immunoglobulin G (IgG), high titers of autoantibodies, and increase of serum alkaline phosphatase and gamma glutamyl transpeptidase activity. A liver biopsy showed sinusoidal dilatation. Fifteen months later, a computed axial tomography showed a retroperitoneal tumor that turned out to be a giant lymph node hyperplasia. After resection of the tumor all clinic and biochemical manifestations had faded, suggesting an association between xanthelasmas, Castleman's disease, sinusoidal dilatation, and celiac disease. A humoral factor produced by the lymph tumor of the patient may have been responsible for the immunologic alterations he presented.