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FDG PET⁄CT Findings in Diagnostic Evaluation of Mononucleosis Mimicking Malignant Lymphoma

DOI: 
10.7727/wimj.2018.149

ABSTRACT

A 43 years old male complaining about high fever, night sweats, cough and unintentional weight loss for two weeks was admitted to the hospital. His blood analysis showed that white blood cell count was 24.1 x 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 considered lymphoma with B symptoms and performed positron emission tomography/computed tomography (PET/CT) with [18F]2-fluoro-2-deoxy-D-glucose (FDG) to determine appropriate lymph node for biopsy. 18F-FDG PET/CT scan showed pathologically FDG uptake in numerous cervical, thoracic and abdominal nodes, liver, spleen and bone marrow. Epstein-Barr virus VCA IgM was found to be positive and resulted in acute EBV titers. The patient’s abnormal 18F-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 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 favor of EBV infection.

Accepted: 
13 Feb, 2020
e-Published: 27 Feb, 2020

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