Figure 4.

Progressive ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomographic (PET) abnormalities preceding symptomatic relapse of Kaposi sarcoma herpesvirus–associated multicentric Castleman disease (KSHV-MCD). Panels show sequential ¹⁸F-FDG PET scans performed in a single patient at time points after the first remission of symptomatic KSHV-MCD. Maximum intensity projections are shown. A, At first remission, the only metabolic abnormality was a mild increase in isolated axillary nodes. B, Four months into remission, while the patient was still clinically asymptomatic, splenic metabolism was mild with was borderline splenomegaly (closed arrow); nodal abnormalities were slightly more prominent. C, Ten months into remission, while the patient was still asymptomatic, splenic metabolism was markedly increased with persisting borderline splenomegaly (closed arrow), and moderately hypermetabolic adenopathy was seen, most marked in the axillary nodes but also involving cervical and inguinal sites (open arrows). Two months later, the patient experienced a symptomatic relapse and was enrolled in the present study and treated. These abnormalities resolved completely with his second remission (not shown).