Malaria masquerading as relapse of Hodgkin′s lymphoma on contrast enhanced ¹⁸ F-fluorodeoxyglucose positron emission tomography/computed tomography: A diagnostic dilemma

Abstract

18Flurodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is nowadays routinely used in management of lymphoma patients. We here present a case of Hodgkin's lymphoma which showed 18F-FDG avid splenomegaly on PET/CT done for clinically suspected relapse. Further evaluation by peripheral smear examination revealed malaria. The patient was then started on anti-malarial medications and follow-up PET/CT revealed resolution of hypermetabolic splenomegaly. This report highlights that in endemic regions malaria can cause 18F-FDG avid splenomegaly and might mimic relapse of lymphoma.

Positron emission tomography and magnetic resonance imaging in experimental human malaria to identify organ-specific changes in morphology and glucose metabolism: A prospective cohort study

“…As access to clinical imaging infrastructure in malaria endemic areas continues to improve, an increasing number of studies have demonstrated the utility of MRI to evaluate the brain in cerebral [ 12 ] and uncomplicated falciparum malaria [ 13 , 14 ]. In contrast, PET imaging in malaria is limited to a small number of nonhuman primate studies [ 15 , 16 ] and a single case report of serendipitous imaging in suspected lymphoma [ 17 ]. In the nonhuman primate studies, uptake of the glucose biomimetic 18-F fluorodeoxyglucose (FDG) was colocated with sequestered infected red blood cells (iRBCs) as ascertained on subsequent autopsy [ 16 ], suggesting that PET imaging using this widely available radiotracer that targets glucose utilization may be a useful modality to localize organ-specific parasite accumulation and host response in life.…”

Positron Emission Tomography and Magnetic Resonance Imaging in Experimental Human Malaria to Identify Organ-Specific Changes in Morphology and Glucose Metabolism: A Prospective Cohort Study

“…As access to clinical imaging infrastructure in malaria endemic areas continues to improve, an increasing number of studies have demonstrated the utility of MRI to evaluate the brain in cerebral [12] and uncomplicated falciparum malaria [13,14]. In contrast, PET imaging in malaria is limited to a small number of nonhuman primate studies [15,16] and a single case report of serendipitous imaging in suspected lymphoma [17]. In the nonhuman primate studies, uptake of the glucose biomimetic 18-F fluorodeoxyglucose (FDG) was colocated with sequestered infected red blood cells (iRBCs) as ascertained on subsequent autopsy [16], suggesting that PET imaging using this widely available radiotracer that targets glucose utilization PLOS MEDICINE may be a useful modality to localize organ-specific parasite accumulation and host response in life.…”