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18F-FDG PET/CT Findings in Cytomegalovirus Colitis.

Anna Sophie L Kjaer1, Iben Ribberholt2, Kim Thomsen3

  • 1Department of Infectious diseases, Copenhagen University Hospital Hvidovre, Kettegaards Allé 30, DK-2650 Hvidovre, Denmark. vqs488@alumni.ku.dk.

Diagnostics (Basel, Switzerland)
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This case study shows that increased 18F-FDG PET/CT uptake in the colon can indicate cytomegalovirus (CMV) colitis, not just inflammatory bowel disease (IBD). Prompt diagnosis and ganciclovir treatment led to patient recovery.

Keywords:
18F-FDG PET/CTcytomegalovirus colitisinflammatory bowel disease

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Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Nuclear Medicine

Background:

  • Azathioprine treatment for inflammatory bowel disease (IBD) can increase the risk of opportunistic infections.
  • Cytomegalovirus (CMV) infection can manifest as colitis, presenting diagnostic challenges.
  • 18F-FDG PET/CT is a valuable imaging modality in IBD management but can show non-specific findings.

Purpose of the Study:

  • To present a case of CMV colitis mimicking IBD activity on 18F-FDG PET/CT.
  • To emphasize the importance of comprehensive diagnostic work-up for colonic symptoms in IBD patients on immunosuppressants.
  • To highlight CMV colitis as a differential diagnosis for abnormal colonic 18F-FDG uptake.

Main Methods:

  • Diagnostic work-up of a patient with IBD on azathioprine presenting with acute symptoms.
  • Utilized 18F-FDG PET/CT imaging to assess colonic inflammation.
  • Performed serological testing for CMV (IgM, IgG), CMV DNA quantification in plasma, and CMV DNA detection in intestinal biopsies.
  • Administered ganciclovir for CMV colitis treatment.

Main Results:

  • 18F-FDG PET/CT revealed pathological uptake in the left colon, suggestive of IBD activity.
  • Diagnosis of CMV colitis was confirmed by positive CMV IgM, IgG seroconversion, CMV DNA in plasma, and CMV DNA in biopsies.
  • Patient showed a positive clinical response to ganciclovir treatment.

Conclusions:

  • 18F-FDG PET/CT findings in the colon can be indicative of CMV colitis.
  • Early and accurate diagnosis of CMV colitis is crucial in immunosuppressed IBD patients.
  • Integrated diagnostic approach combining imaging, serology, and molecular testing is essential.