Atypical Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis simulating lymphadenitis on 18F-FDG PET/CT and its differential diagnosis.

Diagnosis of Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) is challenging as its clinical presentation is atypical. Here we present a case of atypical EBV-HLH simulating lymphadenitis on fluorrine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT), with a view to consider this kind of EBV-HLH as a possible differential diagnosis in lymphadenitis. A 68 years old male who had episodic fever accompanied by weight loss and weakness for two weeks was studied. Finally, biopsies in bone marrow and spleen revealed hemophagocytic cells. He was diagnosed with EBV-HLH and treated with etoposide and prednisone. His condition started improving soon, and his abnormal laboratory findings were normalized at day 15. He remained in good clinical condition at 3 months follow-up after hospital discharge.