Spinal Castleman disease: An imposter–A rare case from Ethiopia

Abstract

Castleman disease is a rare lymphoproliferative disorder that presents significant diagnostic challenges, particularly when involving the spine. Its radiologic features often mimic more common pathologies such as lymphoma, meningioma, metastatic disease, and infection like spinal tuberculosis-conditions frequently encountered in Ethiopia. We report a case of a 62-year-old Ethiopian female who presented with progressive paraparesis. MRI revealed a homogeneously enhancing epidural mass with mildly expansile posterior vertebral elements involvement at the T4 level showing diffusion restriction on DWI/ADC. Differential diagnoses included lymphoma, Plasmacytoma and metastasis. Histopathologic analysis following laminectomy and excision of the epidural mass confirmed hyaline-vascular Castleman disease. Spinal Castleman disease remains a diagnostic imposter, especially in resource-limited settings. Awareness of its imaging features and mimickers is essential to avoid misdiagnosis and guide appropriate management.