Herpes zoster infection mimicking pelvic lymph node metastasis on FDG-PET/CT in a patient with cervical cancer

Document Type : Case report

Authors

1 Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Japan

2 Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan

3 Department of Nuclear Medicine, Hokkaido University Hospital, Sapporo, Japan

4 Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan

5 Department of Obstetrics and Gynecology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan

6 Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo, Japan

Abstract

Although 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is an established method for the staging of malignancies, benign lesions (e.g, active inflammatory lesions) often show increased metabolic activity. Herpes zoster is the clinical manifestation of the activation and replication of dormant varicella-zoster virus (VZV) in individuals with decreased cell-mediated immunity. Although the diagnosis of herpes zoster is clinical, it is sometimes observed incidentally during imaging for another disease. We describe the case of a 67-year-old Japanese female patient diagnosed with cervical cancer in whom FDG-PET/CT revealed herpes zoster manifestations: hypermetabolic cutaneous lesions in the buttock and pelvic lymph node involvement. The resected lymph nodes showed no malignant lesions but revealed lymphoid follicle formation, probably related to viral infection. There has been no report comparing FDG-PET findings of lymph nodes with histologic findings; the present findings are compatible with a clinically VZV-induced inflammatory reaction in regional lymph nodes, which increased FDG accumulation. Active infection with VZV displays increased FDG uptake in regional lymph nodes and may lead to incorrect malignant disease management in oncology. Misdiagnoses can be avoided by a careful interpretation by experienced nuclear medicine physicians as well as proper clinical evaluation.

Keywords

References

1.Harry L I, Medeiros LJ. Ioachim’s Lymph Node Pathology. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2009.
2.Singh D, Kumar R, Prakash G, Bhattacharya A, Mittal B. Active herpes zoster infection involving lumbosacral dermatome, an unusual site of manifestation and incidental finding in fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography scan. World J Nucl Med. 2018; 17(1):52.
3.Lee S, Tsukasaki H, Yamauchi T. Visceral disseminated varicella zoster virus infection with brachial plexus neuritis detected by fluorodeoxyglucose positron emission tomography and computed tomography. J Infect Chemother. 2019; 25(7):556–8.
4.Choi EK, Oh JK, Chung YA. Herpes zoster mimicking breast cancer with axillary lymph node metastasis on PET/CT. Clin Nucl Med. 2015; 40(7):572–3.
5. Sharma R, Jaimini A, Mondal A, Tripathi M. Pitfall of 18F-FDG-PET imaging in oncology: Herpes zoster with axillary lymphadeno-pathy. Hell J Nucl Med. 2008; 11(1):51–2.
6.Wadih A, Rehm PK, Deng C, Douvas M. Active herpes zoster infection with cutaneous manifestation and adenopathy on FDG PET/CT. Radiol Case Reports. 2015; 10(3):27–9.
7.Kerrou K, Montravers F, Grahek D, Younsi N, Perniceni T, Godeberge P, et al. [18F]-FDG uptake in soft tissue dermatome prior to herpes zoster eruption: An unusual pitfall. Ann Nucl Med. 2001; 15(5):455–8.
8.Castellucci P, Nanni C, Farsad M, Alinari L, Zinzani PL, Stefoni V, et al. Potential pitfalls of f-fdg pet in a large series of patients treated for malignant lymphoma: prevalence and scan interpretation. Nucl Med Commun. 2005; 26(8):689–94.
9.Joyce JM, Carlos T. Herpes zoster mimicking recurrence of lymphoma on PET/CT. Clin Nucl Med. 2006; 31(2):104–5.
10.Sheehy N, Israel DA. Acute varicella infection mimics recurrent Hodgkin’s disease on F-18 FDG PET/CT. Clin Nucl Med. 2007; 32(10):820–1.
11.Muzaffar R, Fesler M, Osman MM. Active shingles infection as detected on 18F-FDG PET/CT. Front Oncol. 2013; 3 APR (April): 18–20.
12.Egan C, Silverman E. Increased FDG uptake along dermatome on PET in a patient with herpes zoster. Clin Nucl Med. 2013; 38(9):744–5.
Asia Oceania Journal of Nuclear Medicine and Biology
Volume 9, Issue 2
July 2021
Pages 183-187

Files

Share

How to cite

Statistics