ABSTRACT

A 43-year-old male complaining about high fever, night sweats, cough and unintentional weight loss for 2 weeks was admitted to the hospital. His blood analysis showed that the white blood cell count was 24.1 × 109/L with 58.5% lymphocytosis, where some of them were atypical lymphocytes. Laboratory analysis also showed elevated erythrocyte sedimentation rate, liver enzymes and lactate dehydrogenase. Initially, the Epstein–Barr virus (EBV) serology was found to be negative. Additional imaging methods showed hepatomegaly and cervical, axillary, mediastinal and hilar lymphadenopathy. Due to persistency of clinical symptoms and laboratory findings, we suspected lymphoma with B symptoms and performed positron emission tomography/computed tomography (PET/CT) with [18F]2-fluoro-2-deoxy-D-glucose (FDG) to determine the appropriate lymph node for biopsy. The [18F]2-fluoro-2-deoxy-D-glucose PET/ CT scan showed pathological FDG uptake in numerous cervical, thoracic and abdominal nodes, liver, spleen and bone marrow. Epstein–Barr virus viral capsid antigen IgM was found to be positive and resulted in acute EBV titres. The patient’s abnormal FDG PET/CT scan was most likely secondary to acute EBV infection. The patient was closely monitored without performing lymph node biopsy, and it was observed that symptoms regressed clinically and laboratory results decreased within the normal range in the follow-up controls performed after two months. Our case report indicates that coexisting FDG uptake in the spleen more than in the liver and high FDG uptake in the Waldeyer’s ring should be taken into consideration in favour of EBV infection.