Disseminated nontuberculous mycobacterial infection mimic metastases on PET/CT scan.
A 68-year-old man had malaise, weight loss, and enlarged right cervical lymph nodes. The first biopsy from a right cervical lymph node showed granulomas with negative acid-fast bacillus (AFB) staining, and he was treated for extrapulmonary tuberculosis with isoniazid, rifampin, ethambutol, and pyrazinamide. Symptoms persisted even after receiving antituberculosis drugs for 2 months. He was transferred to our center for F-18 FDG PET/CT scan under the suspicion of occult malignancy. The PET/CT scan showed increased FDG uptake in the right cervical lymphadenopathy and multiple bony lesions. The second biopsy from the FDG-avid cervical lymph node and bone marrow confirmed nontuberculous mycobacterial (NTM) infection. After another 6 months of adjusted antituberculosis therapy with isoniazid, rifampin, ethambutol, and clarithromycin, a repeat PET/CT scan showed remission of previous lesions.
Lin
Kuan-Hsiu
KH
Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Wang
Jao-Hsien
JH
Peng
Nan-Jing
NJ
D000368:Aged; D003937:Diagnosis, Differential; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000556:secondary*; D006801:Humans; D008297:Male; D009164:Mycobacterium Infections / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014376:Tuberculosis / Q000000981:diagnostic imaging
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18