False positive 18F-FDG PET/CT due to active varicella zoster infection in a Hodgkin’s lymphoma patient

سال انتشار: 1397
نوع سند: مقاله کنفرانسی
زبان: انگلیسی
مشاهده: 407

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شناسه ملی سند علمی:

RINMMICMED22_076

تاریخ نمایه سازی: 30 آذر 1398

چکیده مقاله:

Background: We reported a case of Hodgkin lymphoma referred for response assessment after two cycles of chemotherapy. The 18F-FDG PET/CT images showed hypermetabolic cutaneous lesion with a linear pattern in the left arm with significant radiotracer accumulation in the left axillary nodes. On clinical findings, painful papulovesicular rash with dermatomal involvement and palpable enlarged axillary lymph node was compatible with cutaneous herpes zoster infection with reactive lymphadenopathy.Methods: A 31 years old lady with a history of classic type Hodgkin’s lymphoma without unfavorable feature, diagnosed with a prevascular anterior mediastinal mass for seven months was referred to our department for response assessment. She has received two cycles of ABVD regiment without mediastinal radiotherapy, four weeks after the last course of ABVD mid-treatment 18F-FDG PET/CT was done. 18F-FDG PET/CT scan revealed multiple hypermetabolic axillary nodes as well as a subtle linear hypermetabolic cutaneous uptake in the upper left arm in MIP images. with no other pathologic FDG avid lesion throughout the body. Clinically, erythematous vesicles in the left cervical innervation pathognomonic of herpes zoster infection with enlarged axillary lymph nodes were detected. Hypermetabolic axillary lymph nodes were considered due to a reactive response to viral infection. Complete response to therapy was reported. Based on 18F-FDG PET/CT results; the same chemotherapeutic regimen was continued by referring to an oncologic physician. Sixth months following antiviral treatment, axillary lymphadenopathy disappeared on sonographic correlation with no cutaneous lesion. After completion of chemotherapy, the patient was in disease-free without any recurrence symptom.Results: Herein we underlining of this entity that the possibility of an active viral infection in an immunocompromised patient can mimic recurrence disease and emphasize the importance of awareness from patient history and clinical assessment Conclusion: Potential diagnostic errors due to active herpes infection and its associated adenopathy have been reported in a few studies. Several other inflammatory lesions can also cause false positive results in nuclear medicine, especially 18F-FDG PET-CT. Our case also underscores the importance of clinical examination in PET/CT imaging in order to avoid possible false positive results.

نویسندگان

Zakie Nasiri,

Nuclear Medicine Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad

Ramin Sadeghi,

Nuclear Medicine Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad

Zahra Kiamanesh,

Nuclear Medicine Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad

Farnaz Banezhad jannati

Nuclear Medicine Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad