Tuberculosis Lymphadenitis Mimicking Malignancy

Güneren C., Uslu Beşli R. L., Sayman H. B.

EANM, Hamburg, Germany, 19 - 23 October 2024, vol.51, pp.880-881, (Summary Text)

  • Publication Type: Conference Paper / Summary Text
  • Volume: 51
  • Doi Number: 10.1007/s00259-024-06838-z
  • City: Hamburg
  • Country: Germany
  • Page Numbers: pp.880-881
  • Istanbul University-Cerrahpasa Affiliated: Yes

Abstract

Aim/Introduction: Tuberculosis (TB) remains a major health issue in developing countries, however its diagnosis can be challenging and can be confused with malignancy or other granulomatous diseases.

Materials and Methods: We will present a 62-year-old female with sarcoidosis who presented with new-onset headaches, fatigue, night sweats, and weight loss.

Results: Cranial MRI revealed space-occupying lesions, initially suggesting metastasis and prompting surgical consideration. However, lesion regression post-steroid therapy led to a provisional diagnosis of neurosarcoidosis. FDG PET/CT identifed hypermetabolic lesions in lymph nodes, lungs, liver, spleen, and colon. A lymph node biopsy confrmed tuberculous lymphadenitis, and colonoscopy showed granulomatous changes, suggesting TB. Liver biopsies were negative for malignancy, and the patient commenced quadruple antiTB therapy.

Conclusion: Although pulmonary TB is the most common form of the disease, TB can spread to any tissue or organ hematogenously, lymphatically, or through contiguous spread. Hepatobiliary TB is a rare extrapulmonary form, and can mimic malignancies, causing diagnostic delays due to its vague symptoms. In cases of multiple hypermetabolic liver lesions, especially in the immunocompromised, TB should be considered (1,2). FDG PET/CT is invaluable for detecting tuberculous lymphadenitis and is a complementary tool in the diagnosis of extrapulmonary tuberculosis. It can identify lesions missed on morphological imaging, allows for the selection of biopsy site and can diferentiate between active and inactive lesions by detecting early treatment response. However, FDG PET/CT cannot reliably diferentiate tuberculosis lymphadenitis from lymphoma, sarcoidosis, or metastatic lymph nodes. Particularly in countries where tuberculosis is prevalent, considering tuberculous lymphadenitis as a diferential diagnosis in patients with enlarged lymph nodes and the role of lymph node biopsy in the diagnosis in the light of FDG PET/CT fndings is crucial (3,4).

References: 1) Wang X, Shi X, Yi C, et al. Hepatic tuberculosis mimics metastasis revealed by 18F-FDG PET/CT. Clin Nucl Med. 2014;39:325-7 2)Di Renzo C, Tabrizian P, Kozuch DE, et al. Abdominal Tuberculosis Mimicking Cancer Clinically and on Fluorodeoxyglucose (FDG)- Positron Emission Tomography (PET) Imaging: A Two-Case Series. Am J Case Rep. 2020;21:e918901 3)Liao F, Huang Z, Xu R, et al. Analysis of misdiagnosis and 18F-FDG PET/CT fndings of lymph node tuberculosis. J Xray Sci Technol. 2022;30:941-951 4)Yu WY, Lu PX, Assadi M, et al. Updates on 18F-FDG-PET/CT as a clinical tool for tuberculosis evaluation and therapeutic monitoring. Quant Imaging Med Surg. 2019;9:1132-1146.