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. 2023 Feb 23;32(1):90-93.
doi: 10.4274/mirt.galenos.2021.30922.

18F-FDG PET/CT Findings Overlapping Lymphoma in a Patient with Systemic Juvenile Idiopathic Arthritis

Özlem Şahin  1 , Bülent Ataş  2 , Özge Metin Akcan  3 , Ahmet Eren Şen  1
Affiliations

18F-FDG PET/CT Findings Overlapping Lymphoma in a Patient with Systemic Juvenile Idiopathic Arthritis

Özlem Şahin et al. Mol Imaging Radionucl Ther. .

Abstract
in English, Turkish

Systemic juvenile idiopathic arthritis (sJIA) is an important autoinflammatory disease whose first symptom is usually fever, and life-threatening conditions such as macrophage activation syndrome can develop when diagnosis and treatment is delayed. sJIA is an exclusion diagnosis, and there is no specific test that distinguishes it from other febrile diseases. We report the positron emission tomography/computed tomography (PET/CT) findings of sJIA in a 12-year-old girl who presented with fever, rash, and arthralgia. 18F-fluorodeoxyglucose (FDG) uptake was observed in the spleen, bone marrow, and lymph nodes in 18F-FDG PET/CT performed to investigate the etiology of fever of unknown origin. The result of excisional biopsy performed with the suspicion of lymphoma from the left cervical lymph node with intense 18F-FDG uptake was reported as reactive hyperplasia. PET/CT is an alternative diagnostic method for patients with fever of unknown origin. In this case report, we emphasize that in patients with sJIA, there may be intense fluorodeoxyglucose-avid lymph nodes that may lead to the consideration of lymphoproliferative disease, and PET/CT findings along with spleen and bone marrow involvement may overlap with lymphoma.

Sistemik juvenil idiyopatik artrit (sJIA), ilk semptomu genellikle ateş olan önemli bir otoenflamatuvar hastalık olup tanı ve tedavi geciktiğinde makrofaj aktivasyon sendromu gibi hayatı tehdit eden durumlar gelişebilir. sJIA, diğer ateşli hastalıklardan ayıran spesifik testi olmayan bir dışlama tanısıdır. Ateş, döküntü, artralji ile başvuran 12 yaşındaki bir kız çocuğunda sJIA’nın pozitron emisyon tomografi/bilgisayarlı tomografi (PET/BT) bulgularını sunuyoruz. Nedeni bilinmeyen ateş etiyolojisini araştırmak için yapılan 18F-florodeoksiglukoz (FDG)-PET/BT’de dalak, kemik iliği ve lenf düğümlerinde 18F-FDG tutulumu gözlendi. Yoğun 18F-FDG tutulumu olan sol servikal lenf düğümünden lenfoma şüphesiyle yapılan eksizyonel biyopsi sonucu reaktif hiperplazi olarak rapor edildi. PET/BT, nedeni bilinmeyen ateşi olan hastalar için alternatif bir tanı yöntemidir. Bu olgu sunumunda, sJIA’lı hastalarda, lenfoproliferatif hastalık düşünülmesine yol açabilecek yoğun florodeoksiglukoz tutan lenf nodları olabileceğini, dalak ve kemik iliği tutulumu nedeniyle PET/BT bulgularının lenfoma ile örtüşebileceğini vurgulamaktayız.

Keywords: 18F-FDG; PET/CT; fever of unknown origin; juvenile idiopathic arthritis.

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Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

Figures

Figure 1
Figure 1
Increased 18F-fluorodeoxyglucose (FDG) uptake in the cervical, axillary lymph nodes, spleen, and bone marrow in the patient on maximum intensity projection positron emission tomography/computed tomography image (a); bilateral cervical and axillary lymph nodes with increased 18F-FDG uptake (b, c); intraabdominal lymph node with increased 18F-FDG uptake and intense 18F-FDG uptake in the spleen (d)
See this image and copyright information in PMC

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