Pediatric Multicentric Castleman Disease Presented with Spontaneous Tumor Lysis Syndrome and Acute Kidney Injury

Castleman disease (CD) is a rare lymphoproliferative disorder that is uncommon in the pediatric population. Tumor lysis syndrome (TLS) is a rare presentation in CD even after chemotherapy. There is only one case report for pediatric patients with CD where treatment was complicated by TLS. In this case, we report spontaneous TLS and acute kidney injury in a pediatric patient with idiopathic multicentric Castleman disease. Here, we present the case of a 14 year old male with no significant past medical history presented with TLS and AKI (Acute kidney injury). He was found to have idiopathic multicentric CD (iMCD) based on lymph node biopsy. The child was started on Siltuximab and high systemic steroid therapy with significant improvement. A short term continuous renal replacement therapy was required for fluid overload. The patient was discharged home within a month with normal renal function on maintenance therapy. Spontaneous TLS is a rare but significant complication that should be considered in adults and pediatric patients with MCD. Careful monitoring and immediate intervention with supportive care are essential even before the initiation of therapy.