Tuberculosis Infection Could Mimic Malignant Lymphoma In F-18 FDG PET: A Case Report

Ryan Yudistiro, Ivana Dewi Mulyanto, Febby Hutomo, Daniel Chung, Andree Kurniawan, Fajar L. Gultom, Ralph Girson Gunarsa

Abstract


Introduction: Lymphoma and tuberculosis in several cases share similar clinical features that are difficult to differentiate. Lymphadenopathy, fever, malaise, weight loss, and respiratory symptoms are clinical features that could be found in both lymphoma and tuberculosis. Positron Emission Tomography/Computed Tomography Fluorodeoxyglucose (F-18 FDG PET) is a pivotal modality for imaging patients with cancer. Several non-malignant diseases like tuberculosis infection show high FDG uptake and lead to low specificity of F-18 FDG PET.

Case Presentation: This case report describes a 55-year-old male patient with a history of Diffuse Large B-cell Lymphoma (DLBCL) who was suspected of having a recurrent disease. The patient has had a 6-month remission period after 6 cycles of R-CHOP regimen chemotherapy. He denied any known history of tuberculosis infection and HIV. F-18 FDG PET was performed to assess the extent of suspected lymphoma recurrent disease. F-18 FDG PET demonstrated multiple hypermetabolic bilateral neck region, mediastinum, and bilateral axilla lymphadenopathies. There were also multiple high FDG uptakes in the liver, mesocolon, and bones. The patient was suspected of having a lymphoma recurrent disease based on these findings. He underwent an excisional biopsy in the neck and was found to have lymphadenitis granulomatous disease from tuberculosis. Based on the histopathology finding, the patient received anti-tuberculosis drugs for 12 months and showed relief of signs and symptoms. F-18 FDG PET for anti-tuberculosis treatment evaluation revealed a complete metabolic response.

Conclusion: Tuberculosis should be one of the differential diagnoses when a lymphoma recurrent disease is suspected. Clinical features, laboratory results, and imaging findings sometimes show similarities between lymphoma and tuberculosis. Histopathology evaluation is mandatory to confirm the diagnosis.


Keywords


FDG, lymphoma, PET, tuberculosis

References


Uy AB, Garcia AM, Manguba A, Loyola A. Tuberculosis: the great lymphoma pretender. Int J Cancer Res Mol Mech. 2016;2(1):2–5.

Pusat Data dan Informasi Kementerian Kesehatan Republik Indonesia. Infodatin-limfoma 2015. Vol. 1, Infodatin. 2015. p. 1–6.

Marlina I. Tuberkulosis. Infodatin (Pusat Data dan Informasi Kesehatan RI) [Internet]. 2018;2(1):3–4. Available from: https://pusdatin.kemkes.go.id/resources/download/pusdatin/infodatin/infodatin-tuberkulosis-2018.pdf

Thakkar K, Ghaisas SM, Singh M. Lymphadenopathy: Differentiation between tuberculosis and other non-tuberculosis causes like follicular lymphoma. Front Public Heal. 2016;4:10–3.

Dres M, Demoule A, Schmidt M, Similowski T. Tuberculosis hiding a non-Hodgkin lymphoma “ there may be more to this than meets the eye.” Respir Med Case Reports. 2012;7(1):15–6.

Soussan M, Brillet PY, Mekinian A, et al. Patterns of pulmonary tuberculosis on FDG-PET. Eur J Radiol. 2012;81(10):2872–6.

Jehanno N, Cassou-Mounat T, Vincent-Salomon A, et al. PET imaging in management of concomitant Hodgkin lymphoma and tuberculosis - a problem solver tool. Clin Case Reports. 2018;6(1):232–4.

Falagas ME, Kouranos VD, Athanassa Z, Kopterides P. Tuberculosis and malignancy. QJM. 2010;103(7):461–87.

Dobler CC, Cheung K, Nguyen J, Martin A. Risk of tuberculosis in patients with solid cancers and haematological malignancies: A systematic review and meta-analysis. Eur Respir J. 2017;50(2):1700157.

Bomanji JB, Gupta N, Gulati P, Das CJ. Imaging in tuberculosis. Cold Spring Harb Perspect Med. 2015;5(6):1–23.

Okada M, Sato N, Ishii K, et al. F-18 F-18 FDG PET versus CT, MR imaging, and 67Ga scintigraphy in the post therapy evaluation of malignant lymphoma. Radiographics. 2010;30:939-57.

Schoder H. Intensity of 18Fluorodeoxyglucose uptake in positron emission tomography distinguishes between indolent and aggressive Non-Hodgkin’s lymphoma. J Clin Oncol. 2005;23(21):4643-51.

Zuang H, Pourdehnad M, Lambright ES, et al. Dual time point 18F-F-18 FDG PET imaging for differentiating malignant from inflammatory process. J Nucl Med. 2001;42:1412-7.

Kartamihardja AHS, Kurniawati Y, Gunawan R. Diagnostic value of 99mTc-ethambutol scintigraphy in tuberculosis: Compared to microbiological and histopathological tests. Ann Nucl Med. 2018;32(1):60-8.


Full Text: PDF

DOI: 10.33371/ijoc.v14i4.711

Article Metrics

Abstract view : 145 times
PDF - 79 times

Refbacks

  • There are currently no refbacks.


Copyright (c) 2020 Indonesian Journal of Cancer

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.