Though all forms of MCD involve excessive production of cytokines and a cytokine storm, iMCD has important differences in symptoms, disease course, and treatment from POEMS-associated MCD and HHV-8-associated MCD. First line treatment for iMCD is anti-IL-6 therapy with siltuximab (or tocilizumab, if siltuximab is not available). Siltuximab is the only FDA-approved treatment for iMCD and patients who respond to siltuximab tend to have long-term responses. In critically ill patients, chemotherapy and corticosteroids are recommended if the patient is demonstrating disease progression while on siltuximab. Approximately half of iMCD patients do not improve with anti-IL-6 therapy. In patients where siltuximab is not effective, other treatments such as rituximab and sirolimus can be used.iMCD can be further sub-classified into three clinical subgroups:
iMCD with TAFRO Syndrome (iMCD-TAFRO): characterized by acute episodes of Thrombocytopenia, Anasarca, Fever, Renal dysfunction or mylefibrosis, and Organomegaly.iMCD with idiopathic plasmacytic lymphadenopathy (iMCD-IPL): characterized by thrombocytosis, hypergammaglobulinemia, and a more chronic disease course.iMCD, not otherwise specified (iMCD-NOS): is diagnosed in iMCD patients who do not have iMCD-TAFRO or iMCD-IPL. Pathology
Castleman disease is defined by a range of characteristic features seen on microscopic analysis (histology) of tissue from enlarged lymph nodes. Variations in the lymph node tissues of patients with CD have led to 4 histological classifications:

Plasmacytic: increased number of follicles with large hyperplastic germinal centers and sheetlike plasmacytosis (increased number plasma cells). Germinal centers may also show regressed features
Hyaline vascular: regressed germinal centers, follicular dendritic cell prominence or dysplasia, hypervascularity in interfollicular regions, sclerotic vessels, prominent mantle zones with an "onion-skin" appearance.
Birth injury refers to damage or injury to the child before, during, or just after the birthing process. "Birth trauma" refers specifically to mechanical damage sustained during delivery (such as nerve damage and broken bones).The term "birth injury" may be used in two different ways:

the ICD-10 uses "birth injury" and "birth trauma" interchangeably to refer to mechanical injuries sustained during delivery;
the legal community uses "birth injury" to refer to any damage or injury sustained during pregnancy, during delivery, or just after delivery, including injuries caused by trauma.Birth injuries must be distinguished from birth defects. "Birth defect" refers to damage that occurs while the fetus is in the womb, which may be caused by genetic mutations, infections, or exposure to toxins. There are more than 4,000 types of birth defects. Causes
Difficult labor (dystocia)
Difficult labor, also known as dystocia or obstructed labor, occurs when the child cannot easily pass through the birth canal. This can result in fetal distress or physical trauma to the child, especially broken clavicles and damage to the brachial plexus nerves. It can also deprive the child of oxygen as the umbilical cord is pinched, potentially causing brain damage or death.Difficult labor may occur because the baby is abnormally large (macrosomia), because the mothers pelvis or birth canal is small or deformed, or because the baby is in an abnormal presentation for the birth (such as breech or transverse presentation). External causes
Fetal malformations and birth injuries may occur as a result of exposure to environmental toxins such as mercury or lead.