FDG-PET is an essential diagnostic tool in the management of Hodgkin's lymphoma (HD). However, a lot of benign conditions are well-known to present with high FDG uptake thus mimicking malignant activity. Tuberculosis (TBC) is an infection with known high FDG accumulation and should be suspected in patients with lymphoma and those treated with chemotherapy.
CASE REPORT: We present a 19-year old female with mediastinal Hodgkins lymphoma who had discrete lung changes on presentation. After initial chemotherapy, patients status worsened, with CT scan showing complete resolution of the mediastinal mass along with progression in the lung. Patient was restaged and mediastinal and lung involvement was proven. Therapy was escalated with further worsening and newly found liver lesions. TBC was clinically suspected although not objectively proven. FDG PET scan revealed high activity infiltrative lung changes, diffuse pleural activity, active liver lesions and celiac lymph nodes. However, changes could not be addressed as malignant, due to TBC or to both. Pleural biopsy revealed TBC. Patient received anti-TBC treatment only. The follow-up FDG PET scan revealed almost complete resolution of all the changes consistent with complete remission of the lymphoma and good treatment response of TBC.
CONCLUSION: Based on initial CT report we consider this case a coexistence of TBC and HD at initial presentation with further worsening rather than a newly-developed TBC on an immunosupressed ground. FDG PET is an excellent tool in HD management, but falsely positive results from TBC should be kept in mind, especially when lung in involved.
Scripta Scientifica Medica 2013; 45(1): 82-84.
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