Active herpes zoster infection with cutaneous manifestation and adenopathy on FDG PET/CT

Abstract

We report a patient with history of Hodgkin lymphoma. Six months after treatment, 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography and/or computed tomography ([18F] FDG PET/CT) scan showed abnormal uptake in right axillary lymph nodes concerning for recurrence. In addition, PET/CT showed a new hypermetabolic skin lesion overlying the right scapula. Clinical evaluation was consistent with shingles, and the patient was treated with valacyclovir. Subsequent PET/CT scan was normal with no evidence of lymphoma. Although there have been reported cases of abnormal FDG in nodes or in skin due to herpes zoster, our case is unique in the literature in that the PET/CT demonstrates abnormalities involving both the skin and associated lymph nodes. The possibility of false positive uptake, not because of recurrent malignancy, must always be considered when abnormal FDG uptake is noted in the follow-up of oncology patients. Careful review of the scan and correlation with clinical findings can avoid false positive interpretation and facilitate patient management.

Keywords: Adenopathy; Herpes zoster; Lymphoma; PET CT; Shingles.

Fig. 1

Coronal (A), sagittal (B), and axial (C) attenuation-corrected 2-deoxy-2-[18F]fluoro-d-glucose (FDG) positron emission tomography images showing the right axillary adenopathy with significant increased FDG uptake and the focal hypermetabolic skin lesion overlying the right scapula. The arrows point to the abnormal uptake in the right axilla and skin.

Fig. 2

Axial computed tomography (CT) and fused positron emission tomography/CT images of the chest showing focal skin thickening and increased 2-deoxy-2-[18F]fluoro-d-glucose uptake overlying the right scapula (A, B) in addition to the hypermetabolic right axillary adenopathy (C, D).