18F-FDG-PET Positive Sarcoidosis Post Chemoradiotherapy for Hodgkin's Disease : a case report

IntroductionThe occurrence of granulomatous disease in the setting of Hodgkin's disease is rare, however when it occurs can pose significant clinical and diagnostic challenges for physicians treating these patients.Case PresentationWe report a 33 year old Caucasian woman of Mediterranean descent with newly diagnosed FDG PET/CT scan positive early stage Hodgkin's disease involving cervical nodes who despite having an excellent clinical response to chemotherapy had a persistently positive FDG-PET positive study suggestive of residual or progressive disease. Subsequent biopsy of post chemotherapy PET positive nodes demonstrated sarcoidosis with no evidence of Hodgkin's disease.

Conclusion: This case highlights abnormalities on post therapy PET/CT scan in patient's with Hodgkin's disease are not always due to residual or progressive disease.

An association between Hodgkin's disease and/or its treatment with an increased incidence of granulomatous disease appears to exist. Certain patterns of FDG uptake on PET/CT scan may suggest alternate pathologies such as granulomatous inflammation and due to significant differences in prognosis and management, clinicians should maintain a low threshold for histopathological evaluation when PET/CT results appear incongruent with clinical response.

Author: Martin CherkAlan PhamAndrew Haydon
Credits/Source: Journal of Medical Case Reports 2011, 5:247

Published on: 2011-06-29

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