A Case Report: Systemic Lymph Node Tuberculosis Mimicking Lymphoma on 18F-FDG PET/CT

Area of Science:

• Oncology
• Infectious Diseases
• Radiology

Background:

• F-fluorodeoxyglucose positron emission tomography (FDG-PET) is a key imaging technique for malignancy detection.
• FDG-PET uptake can be elevated in inflammatory conditions, potentially leading to misdiagnosis.
• Differentiating between malignancy and inflammatory causes of lymphadenopathy is clinically significant.

Observation:

• A 21-year-old male presented with chronic right lower quadrant abdominal pain and asymptomatic, widespread lymphadenopathy.
• Initial investigations including colonoscopy revealed no organic pathology.
• Ultrasound confirmed multiple enlarged lymph nodes in the neck, axilla, and groin.

Findings:

• FDG-PET demonstrated intense radiotracer accumulation in multiple lymph node regions, suggestive of lymphoma.
• Despite imaging findings typical for lymphoma, a biopsy of a supraclavicular lymph node confirmed tuberculosis.
• The patient had no constitutional symptoms typically associated with tuberculosis.

Implications:

• This case emphasizes the importance of considering lymph node tuberculosis in the differential diagnosis of lymphoma, especially in endemic areas.
• Unexplained lymphadenopathy with high FDG uptake on PET scans requires careful pathological correlation to avoid misdiagnosis.
• Awareness of this diagnostic challenge can improve patient outcomes by ensuring timely and appropriate treatment for tuberculosis.