title: Active herpes zoster infection with cutaneous manifestation and adenopathy on FDG PET/CT.
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.
authors.affiliation: Division of Nuclear Radiology, University of Virginia Medical Center, Charlottesville, VA, USA.
authors.forename: Antoine
authors.initials: A
authors.lastname: Wadih
authors.affiliation: Division of Nuclear Radiology, University of Virginia Medical Center, Charlottesville, VA, USA.
authors.forename: Patrice K
authors.initials: PK
authors.lastname: Rehm
authors.affiliation: Division of Nuclear Radiology, University of Virginia Medical Center, Charlottesville, VA, USA.
authors.forename: Chunli
authors.initials: C
authors.lastname: Deng
authors.affiliation: Division of Hematology, University of Virginia Medical Center, Charlottesville, VA, USA ; Division of Oncology, University of Virginia Medical Center, Charlottesville, VA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Douvas
keywords: Adenopathy; Herpes zoster; Lymphoma; PET CT; Shingles