Hepatic candidiasis mimicking lymphoma on 18 F-FDG PET/CT in a patient with T cell lymphoma
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Hepatic candidiasis mimicking lymphoma on 18F-FDG PET/CT in a patient with T cell lymphoma Sandra Schwerz 1 & Marguerite Mueller 1 & Katharina Lindemann-Docter 2 & Alexander Heinzel 1 & Felix M Mottaghy 1,3 & Mohsen Beheshti 1,4 Received: 17 March 2020 / Accepted: 8 April 2020 # The Author(s) 2020
A 19-year-old woman with a history of lymphoblastic T cell lymphoma and mediastinal residual mass after chemotherapy underwent 18F-FDG PET/CT for assessment of treatment response. Informed consent was obtained from the participant included in the study. 18F-FDG PET/CT showed multiple foci with intensive tracer uptake in both hepatic lobes (A and C—arrows), suggestive of hepatic candidiasis mainly because of the history of previous hepatic candidiasis abscesses (4 months before). However, due to lack of clinical symptoms, intensive 18F-FDG avid lesions under antifungal therapy, borderline serum beta-Dglucan (63 pg/mL), and differential diagnosis of liver metastases of lymphoma, further histological verification was performed. The histopathological findings (hematoxylin and eosin stain) revealed focal fibrosis with proliferating bile ducts, foamy cells, and lymphocytes (G and H), correlating with reactive and resorptive processes following the preexisting hepatic abscesses (E and F). Antifungal treatment with posaconazole 300 mg was continued leading to complete remission of the disease assessed by follow-up 18F-FDG PET/CT after 3 months (B and D). The residual mediastinal mass showed only faint uptake on both 18 F-FDG PET/CT studies suggestive of Deauville score 2. This case presents an unusual pitfall of 18F-FDG PET/CT in assessment of liver disease and emphasizes again on the value of 18 F-FDG PET/CT in the detection of invasive fungal infection, a This article is part of the Topical Collection on Image of the month.
severe infection in the immunocompromised patients, and also its usefulness in assessing response to treatment [1–4].
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Compliance with ethical standards Conflict of interest The authors declare that they have no conflict of interest. Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent Informed consent was obtained from the participant included in the study. Open Access This article is licensed under a Creative Commons
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