We describe a case of histologically proven multicentric Castleman's disease in a 68 year old man. The clinical picture was dominated by severe hemolytic anemia. The outcome was fatal despite active treatment. We discuss the main pathological and clinical characteristics distinguishing multicentric Castleman's disease from the localized variant. The different age distribution, localized versus multicentric disease, different responses to treatment, and outcome, indicate that the two types of Castleman's disease represent different entities presenting common histological features in the lymphoid lesions.