Epstein-barr virus mimicking lymphoma on FDG-PET/CT

Division of Nuclear Medicine, Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
Clinical nuclear medicine (Impact Factor: 3.93). 12/2009; 34(12):891-3. DOI: 10.1097/RLU.0b013e3181bed135
Source: PubMed


We report the case of a 17-year-old girl who presented with a several month history of fevers and abdominal pain. After cytomegalovirus (CMV) and Epstein-Barr virus (EBV) titers returned normal, FDG-PET/CT was obtained due to concern for lymphoma. FDG-PET/CT revealed a pattern of hypermetabolic activity in the adenoids, bilateral cervical lymph nodes, abdominal lymph nodes, and spleen, highly concerning for lymphoma. However, subsequent biopsy of a cervical lymph node revealed lymphadenitis consistent with EBV. This case highlights infection as the most well-known false-positive cause on FDG-PET, and how biopsy is essential to definitively distinguish malignancy from infection.

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    • "Since PET/CT is rarely used as a diagnostic tool to detect a primary EBV infection in daily clinical practice, only a few case reports have been published. These cases demonstrated that F18-FDG uptake can be intense in lymph nodes and spleen and may mimic lymphoma [4-6]. The choice to opt for interim F18-FDG PET/CT scans was not only based on the combination of the young age of our patient and the prognostic implications of his relapse. "
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    ABSTRACT: Introduction Hodgkin’s disease is highly curable by radiotherapy and/or chemotherapy, but refractory disease or early relapses are rarely cured by conventional salvage therapy. Case presentation We report a case of a 20-year-old Caucasian man, with a biopsy-proven intrapulmonary relapse of Hodgkin’s disease, for whom salvage chemotherapy was administered. During salvage chemotherapy intense increased F18-fluorodeoxyglucose uptake was noticed in multiple lymph nodes and diffuse increased splenic uptake, suggesting chemotherapy-refractory disease. However, additional information obtained from the patient revealed he recently had met his first girlfriend. An asymptomatic primary Epstein–Barr virus infection was considered proven. Conclusions Interim F18-fluorodeoxyglucose-positron emission tomography/computed tomography is a strong prognostic factor for advanced Hodgkin’s and may better identify those patients needing intensified chemotherapy. Related to the nonspecificity of F18-fluorodeoxyglucose, clinical awareness of the potential interference of intercurrent asymptomatic viral infections with treatment and remission status monitoring continues to be important in the interpretation of equivocal medical imaging results.
    Journal of Medical Case Reports 06/2014; 8(1):212. DOI:10.1186/1752-1947-8-212
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