Idiopathic multicentric Castleman disease of TAFRO subtype

A 57-year-old woman with a history of autoimmune thrombocytopenic purpura (ITP) presented with cough, shortness of breath, pyrexia and anasarca. Laboratory tests showed anaemia (haemoglobin concentration 84 g/l), thrombocytopenia (platelet count nadir 5 × 109/l), raised inflammatory markers and acute kidney injury. A direct Coombs test was strongly positive (IgG, IgM and C3d) and the blood film showed teardrop poikilocytes, nucleated red blood...