Systemic Lupus Erythematosus Associated Pitfalls on 18F-FDG PET/CT: Reactive Follicular Hyperplasia, Kikuchi-Fujimoto Disease, Inflammation and Lymphoid Hyperplasia of the Spleen Mimicking Lymphoma

Makis, William; Ciarallo, Anthony; Gonzalez-Verdecia, Milene; Probst, Stephan

doi:10.1007/s13139-017-0471-z

Cited by 22 publications

(12 citation statements)

References 17 publications

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“…KFD is a benign and self-limiting disease, and its main features are acute or subacute cervical lymphadenopathy and fever. 6 KFD most commonly affects <30-year-old female patients of Asian origin; 7 , 8 it less commonly develops in men, as in the present case. KFD can predispose to FDG uptake in localized lymph nodes and limit the specificity of FDG PET/CT by mimicking malignant lymphoma.…”

Section: Case Reportsupporting

confidence: 61%

Positron emission tomography/computed tomography hypermetabolism of Kikuchi–Fujimoto disease mimicking malignant lymphoma: a case report and literature review

Wang

et al. 2021

J Int Med Res

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Kikuchi–Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a benign, self-limiting inflammatory disorder of unknown etiology and pathogenesis. This report presents a rare case involving a man with 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) hypermetabolism caused by KFD mimicking malignant lymphoma. The PET/CT maximum intensity projection showed multiple hypermetabolic lymphadenopathies and homogeneous FDG uptake in the bone marrow and spleen. Malignant lymphoma was initially suspected. The patient then underwent excision biopsy of one enlarged right cervical lymph node that was selected because it showed the highest FDG uptake in PET/CT, and examination of this biopsy specimen confirmed the diagnosis of KFD. PET/CT is useful for assessing the general condition of patients and can help to select lymph nodes for excision biopsy based on the highest FDG uptake. However, KFD can predispose to localized FDG uptake and limit the specificity of PET/CT by mimicking malignancy. Thus, positive results of PET/CT should be interpreted with caution.

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Section: Case Reportsupporting

confidence: 61%

Positron emission tomography/computed tomography hypermetabolism of Kikuchi–Fujimoto disease mimicking malignant lymphoma: a case report and literature review

Wang

et al. 2021

J Int Med Res

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“…[ 11 ] This phenomenon, along with reactive follicular hyperplasia, harboring a variety of hypermetabolic, dividing cells, can lead to false positive 18 F-FDG PET/CT results in both non-malignant and lymphoma conditions. [ 12 ] Among dasatinib associated lymphadenopathy cases, 2 reported PET/CT results with hypermetabolic lymphadenopathy but further details were not provided. [ 3 , 5 ] It should be noted that hypermetabolic lymphadenopathy in PET scan has been described in drug induced hypersensitivity syndrome (DIHS) secondary to minocycline, [ 13 ] but whether drug induced lymphadenopathy should be considered as part of the same spectrum of disease as DIHS is under debate, [ 14 ] since their exact pathophysiological mechanisms are not well understood and no common underlying mechanism has yet been confirmed.…”

Section: Discussionmentioning

confidence: 99%

Dasatinib associated lymphadenopathy in a chronic myeloid leukemia patient

Pilalas

Κoletsa²,

Arsos

et al. 2020

Medicine

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Rationale: Dasatinib associated lymphadenopathy (DAL) is a rare adverse event in chronic myeloid leukemia patients (CML). A case of voluminous lymphadenopathy in the context of DAL is presented. Patient concerns: A 40-year-old male patient was diagnosed with BCR-ABL1 positive chronic stage CML 2 years ago and achieved complete molecular response on nilotinib, which was switched to dasatinib due to nilotinib intolerance. After 5 months on dasatinib, the patient presented with a large mass in the axillary region. Diagnosis: Common infectious and autoimmune etiologies of lymphadenopathy were ruled out. The positron emission tomography/computed tomography (PET/CT) demonstrated a hypermetabolic lymphadenopathy highly suspicious of lymphoma. The subsequent biopsy excluded lymphoma or extramedullary blastic transformation of CML and revealed reactive lymphadenopathy with mixed (cortical and paracortical) pattern. Clinical history and clinicopathological correlation suggested the diagnosis of DAL. Intervention: Dasatinib was discontinued and the patient remained in close follow-up. TKI treatment with nilotinib was reinitiated. Outcomes: Lymphadenopathy resolved clinically at 4 weeks and normalization of PET/CT findings was documented at 9 weeks after cessation of the drug. TKI treatment with nilotinib was reinitiated with good tolerance. Lessons: DAL may present with voluminous lymphadenopathy consistent with malignancy in clinical and imaging workup. We describe the spectrum of lesions associated with DAL and identify common features with drug-induced lymphadenopathy.

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“…Bei Patienten mit bekanntem systemischem Lupus erythematodes (SLE), die zur [ 18 F]FDG-PET/CT-Untersuchung mit der Fragestellung Verdacht auf Lymphom überwiesen werden, muss einem bewusst sein, dass die Lymphominzidenz bei SLE-Patienten erhöht ist, allerdings kann die SLE-assoziierte Lymphadenopathie, eine reaktive follikuläre Hyperplasie, ebenfalls zu einer [ 18 F]FDG-Anreicherung in Lymphknoten führen. Ein weiterer potenzieller SLE-assoziierter Pitfall ist die diffus erhöhte FDG-Anreicherung in der Milz von SLE-Patienten, deren zugrunde liegende Ätiologie jedoch noch unbekannt ist [52].…”

Section: Infektionen Und Entzündungenunclassified