Diffuse bone marrow uptake on ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography with...

Area of Science:

• Nuclear Medicine
• Hematology
• Nutritional Science

Background:

• Positron emission tomography/computed tomography (PET/CT) with 18F-fluorodeoxyglucose (FDG) is crucial for cancer staging.
• Diffuse bone marrow uptake of 18F-FDG can indicate malignancy but also other conditions.
• Pancytopenia necessitates thorough investigation to determine the underlying cause.

Observation:

• A 59-year-old male with pancytopenia presented with diffuse bone marrow uptake on 18F-FDG PET/CT, initially suspected as carcinomatosis.
• Bone marrow biopsy showed no malignant cells but revealed erythroblasts with cytoplasmic vacuolization.
• Laboratory tests confirmed low serum copper and ceruloplasmin levels, indicative of copper deficiency.

Findings:

• Copper deficiency was identified as the cause of the patient's pancytopenia and abnormal bone marrow uptake on PET/CT.
• Copper supplementation led to a significant improvement in cytopenia.
• Subsequent 18F-FDG PET/CT scans demonstrated a marked decrease in bone marrow uptake.

Implications:

• This case underscores the importance of considering copper deficiency in the differential diagnosis of diffuse bone marrow uptake on 18F-FDG PET/CT.
• It highlights the potential for nutritional deficiencies to mimic oncological findings on advanced imaging.
• Early recognition and management of copper deficiency can prevent unnecessary investigations and treatments for malignancy.