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-D-glucan (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 18F-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 18F-FDG PET/CT in the detection of invasive fungal infection, a severe infection in the immunocompromised patients, and also its usefulness in assessing response to treatment [1–4].
Funding Information
Open Access funding provided by Projekt DEAL.
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.
Footnotes
This article is part of the Topical Collection on Image of the month.
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.Albano D, Bosio G, Bertoli M, Petrilli G, Bertagna F. Hepatosplenic candidiasis detected by (18)F-FDG-PET/CT. Asia Oceania J Nuclear Med Biol. 2016;4(2):106–108. doi: 10.7508/aojnmb.2016.02.007. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Leroy-Freschini B, Treglia G, Argemi X, Bund C, Kessler R, Herbrecht R, Imperiale A. 18F-FDG PET/CT for invasive fungal infection in immunocompromised patients. QJM : Monthly Journal of the Association of Physicians. 2018;111(9):613–622. doi: 10.1093/qjmed/hcy128. [DOI] [PubMed] [Google Scholar]
- 3.Ankrah AO, Span LFR, Klein HC, de Jong PA, Dierckx R, Kwee TC, Sathekge MM, Glaudemans A. Role of FDG PET/CT in monitoring treatment response in patients with invasive fungal infections. Eur J Nucl Med Mol Imaging. 2019;46(1):174–183. doi: 10.1007/s00259-018-4192-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Douglas AP, Thursky KA, Worth LJ, Drummond E, Hogg A, Hicks RJ, Slavin MA. FDG PET/CT imaging in detecting and guiding management of invasive fungal infections: a retrospective comparison to conventional CT imaging. Eur J Nucl Med Mol Imaging. 2019;46(1):166–173. doi: 10.1007/s00259-018-4062-8. [DOI] [PubMed] [Google Scholar]