Elevated FAPI Activity in Ulcerative Fungal Esophagitis

Area of Science:

• Medical Imaging
• Mycology
• Gastroenterology

Background:

• Esophageal masses often require differential diagnosis including malignancy and infection.
• Positron emission tomography (PET) tracers like 18F-FDG are used to assess metabolic activity.
• Novel tracers like 68Ga-FAPI target fibroblast activation, common in cancer and inflammation.

Observation:

• A case presented with an ulcerative fungal esophagitis.
• The condition showed elevated uptake of 18F-FDG on PET imaging.
• Significantly, there was also increased uptake of 68Ga-FAPI in the affected esophagus.

Findings:

• Ulcerative fungal esophagitis demonstrated increased radiotracer accumulation.
• The pattern of uptake, particularly with 68Ga-FAPI, resembled that of esophageal cancer.
• This highlights the potential for misdiagnosis based solely on imaging findings.

Implications:

• Consider fungal esophagitis in the differential diagnosis of esophageal masses with increased 68Ga-FAPI uptake.
• This finding may refine the interpretation of PET/CT scans in esophageal diseases.
• Further research is needed to delineate imaging characteristics of fungal esophagitis versus malignancy.