Active herpes zoster infection with cutaneous manifestation and adenopathy on FDG PET/CT

Abstract

We report a patient with history of Hodgkin lymphoma. Six months after treatment, 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography and/or computed tomography ([18F] FDG PET/CT) scan showed abnormal uptake in right axillary lymph nodes concerning for recurrence. In addition, PET/CT showed a new hypermetabolic skin lesion overlying the right scapula. Clinical evaluation was consistent with shingles, and the patient was treated with valacyclovir. Subsequent PET/CT scan was normal with no evidence of lymphoma. Although there have been reported cases of abnormal FDG in nodes or in skin due to herpes zoster, our case is unique in the literature in that the PET/CT demonstrates abnormalities involving both the skin and associated lymph nodes. The possibility of false positive uptake, not because of recurrent malignancy, must always be considered when abnormal FDG uptake is noted in the follow-up of oncology patients. Careful review of the scan and correlation with clinical findings can avoid false positive interpretation and facilitate patient management.

Preclinical evaluation of [18F]FDG-PET as a biomarker of lymphoid tissue disease and inflammation in Zika virus infection

“…However, this current study confirmed that in DENV, spleen [ 18 F]FDG uptake is still sufficiently sensitive as a possible imaging biomarker for disease and more closely recapitulates the clinical PET/CT observations in DENV patients [ 11 , 12 ]. Aside from DENV and ZIKV, lymphoid tissue [ 18 F]FDG uptake has also been reported in other viral infections, seen in [ 18 F]FDG-PET images of patients infected with chikungunya virus [ 39 ], reactivated Epstein-Barr virus [ 40 – 42 ], and reactivated varicella zoster virus or shingles [ 43 ]. Lymphoid tissue FDG uptake was also captured in non-human primate models of monkeypox virus infection [ 44 , 45 ].…”

Unusual Presentation of Herpes Zoster Infection Mimicking Soft Tissue Metastases of Breast Cancer on 18F-FDG PET/CT Imaging

“…1,2 There are some reports that this disease may cause false-positive scan in cancer patients. [3][4][5][6][7] Our case presented with disseminated multiple skin lesions, which is called bilateral herpes and is a very rare clinical manifestation, 2 mimicking soft tissue metastasis and left axillary lymph node uptake probably because of infection/inflammation. That is a quite unusual presentation compared with previous reports that show only 1 dermatome site or lymph node infiltration.…”

Active herpes zoster infection involving lumbosacral dermatome, an unusual site of manifestation and incidental finding in fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography scan

“…[ 3 4 5 6 7 ] However, Wadih et al . [ 8 ] and Sharma et al . [ 9 ] reported the presence of both the active cutaneous manifestation and lymph nodes involvement in the same patient during PET scan.…”

“…A few previously reported case reports of FDG-PET scan in oncology patients with herpes zoster infection showed either the presence of active cutaneous lesions or hypermetabolic lymph nodes. [3][4][5][6][7] However, Wadih et al [8] and Sharma et al [9] reported the presence of both the active cutaneous manifestation and lymph nodes involvement in the same patient during PET scan.…”