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.
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    ABSTRACT: We report a case of a 46-year-old woman with a history of endometrial stroma sarcoma who received hysterec-tomy and bilateral oophrectomy a few years ago. During the follow up, her serum CA-125 elevated to 67.9 U/ml. An FDG-PET scan was obtained due to the concern about tumor recurrence. The whole body FDG-PET scan revealed an area with hypermetabolic activity in the perineum with SUVmax of 3.1 and 4.9 at 1 h and 3 h post-injection, respectively. Tumor recurrence was con-sidered. However, a biopsy was performed and the pathologic diagnosis was condyloma acuminatum. To the best of our knowledge, this is the first reported case of increased FDG uptake in a condyloma acuminatum.
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