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[¹⁸F-FDG PET-CT in cytomegalovirus-induced mononucleosis]
1Proyecto OTRI de Investigación, Grupo Hospitalario Quirón y Universidad de Zaragoza, Unidad de Medicina Nuclear, Grupo Hospitalario Quirón, La Floresta, Zaragoza, España. jbanzoma@unizar.es
Insights
A 51-year-old woman with a history of breast cancer was diagnosed with Cytomegalovirus (CMV) mononucleosis. Prompt diagnosis of infectious mononucleosis (IM) in older adults is crucial to prevent unnecessary tests.
Area of Science:
- Infectious Diseases
- Oncology
- Radiology
Background:
- A 51-year-old woman presented with symptoms suggestive of malignancy recurrence, including fever, asthenia, and weight loss.
- Her medical history included breast cancer with liver metastases, complicating the diagnostic process.
Observation:
- Physical examination revealed painless, enlarged lymph nodes in the cervical chains.
- Blood tests showed lymphocytosis and elevated liver enzymes, with negative cultures but positive anti-CMV IgM.
- PET/CT imaging indicated hypermetabolic lymphadenopathy and splenomegaly, consistent with infection.
Findings:
- The patient was diagnosed with Cytomegalovirus (CMV) mononucleosis, not cancer recurrence.
- Her clinical condition improved with appropriate diagnosis and management.
Implications:
- This case highlights the importance of considering infectious mononucleosis (IM) in older adults presenting with atypical symptoms.
- Accurate diagnosis of IM can prevent extensive and unnecessary investigations for malignancy or other conditions.
- Early identification of CMV infection is vital for timely and effective patient management.
Abstract:
The case of a 51 years-old woman with high fever, asthenia and weight loss of three weeks of evolution is presented. She had a personal history of breast cancer and liver metastases. The physical examination showed small painless enlarged lymph nodes in both latero-cervical chains. The blood analysis showed 9200 leukocytes with 69% of lymphocytes and elevated liver enzymes. Serological determinations as well as repeated blood and urine culture were negatives, only the anti-CMV IgM determination being positive. The CEA tumor marker was slightly elevated. PET/CT demonstrated hypermetabolic enlarged lymph nodes in the bilateral cervical chains and in celiac region, hepatosplenomegaly and diffusely increased ¹⁸F-FDG uptake in the spleen. These alterations were associated with CMV infection. Her evolution was favorable, and she was diagnosed of CMV mononucleosis. The appropriate clinical and immunological diagnosis of IM in patients aged over 40 years is important to avoid unnecessary diagnostic procedures.
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