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Takeshi Shimamoto
Takeshi Nishina
Masashi Komeda
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J Thorac Cardiovasc Surg 2009;138:499-501
© 2009 The American Association for Thoracic Surgery

Brief Clinical Report

A case of interleukin-6–producing cardiac myxoma resembling multicentric Castleman's disease

Atsutomo Morishima, MD*, Akira Marui, MD, PhD*,*, Takeshi Shimamoto, MD, Yoshiaki Saji, MD, Takeshi Nishina, MD, PhD, Masashi Komeda, MD, PhD

Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan

Received for publication March 21, 2008; accepted for publication May 4, 2008.

* Address for reprints: Akira Marui, MD, PhD, Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara, Sakyo, Kyoto, 606-8507 Japan. (Email: marui@kuhp.kyoto-u.ac.jp).

The first 20% of the full text of this article appears below.


   Introduction
 
Cardiac myxoma sometimes presents constitutive symptoms such as fever and weight loss because of a production of interleukin-6 (IL-6).1,2Go Castleman's disease (CD) presents constitutional symptoms with lymphadenopathy, plasma cell infiltration, polyclonal hypergammaglobulinemia, and inflammatory reaction, which has been reported to be caused by an overproduction of IL-6.3-5Go Here, we report a rare case of IL-6-producing cardiac myxoma resembling multicentric CD with plasma cell infiltration.


   Clinical Summary
 
A 78-year-old man had weight loss, low-grade fever, and advanced anemia for 6 months. After he was referred to our hospital, gastrointestinal examination revealed no malignant lesions. A chest x-ray film showed no pulmonary congestion or cardiomegaly (cardiothoracic ratio = 48%). Findings on an electrocardiogram were not remarkable. Laboratory data showed low white blood cell count, anemia, and a severe inflammatory reaction (c-reactive reaction and erythrocyte sedimentation rate; Figure 1 ). The laboratory data also revealed polyclonal hypergammaglobulinemia and hypoalbuminemia (Figure 1). We initially suspected myelodysplastic syndrome because of the constitutive symptoms and hematologic abnormalities; however, the chromosome examination revealed no abnormality. On further examination, abnormal plasma cell infiltration, erythroid hypoplasia in bone marrow (Figure 2 ), and a marked increase in plasma IL-6 (26.2 pg/mL, normal ≤ 4 pg/mL) were observed, which led to suspicion of multicentric CD with plasma cell infiltration. Thus, steroid . . . [Full Text of this Article]






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