Active herpes zoster infection with cutaneous manifestation and adenopathy on FDG PET/CT

• Published in: Radiology case reports Vol. 10; no. 3; pp. 27 - 29
• Main Authors: Wadih, Antoine, MD, Rehm, Patrice K., MD, Deng, Chunli, MD, Douvas, Michael, MD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.10.2015; Elsevier
• Subjects: Adenopathy; Case Report; Herpes zoster; Lymphoma; PET CT; Radiology; Shingles; Shingles; Herpes zoster; PET CT; Lymphoma; Adenopathy
• ISSN: 1930-0433; 1930-0433
• DOI: 10.1016/j.radcr.2015.06.006

Abstract We report a patient with history of Hodgkin lymphoma. Six months after treatment, 2-deoxy-2-[18F]fluoro- d -glucose positron emission tomography and/or computed tomography ([18F] FDG PET/CT) scan showed abnormal uptake in right axillary lymph nodes concerning for recurrence. In addition, PET/CT showed a new hypermetabolic skin lesion overlying the right scapula. Clinical evaluation was consistent with shingles, and the patient was treated with valacyclovir. Subsequent PET/CT scan was normal with no evidence of lymphoma. Although there have been reported cases of abnormal FDG in nodes or in skin due to herpes zoster, our case is unique in the literature in that the PET/CT demonstrates abnormalities involving both the skin and associated lymph nodes. The possibility of false positive uptake, not because of recurrent malignancy, must always be considered when abnormal FDG uptake is noted in the follow-up of oncology patients. Careful review of the scan and correlation with clinical findings can avoid false positive interpretation and facilitate patient management.