Hepatic candidiasis mimicking lymphoma on 18F-FDG PET/CT in a patient with T cell lymphoma.

A 19-year-old woman with a history of lymphoblastic T cell lymphoma and mediastinal residual mass after chemotherapy underwent 18F-FDG PET/CT for assessment of treatment response. Informed consent was obtained from the participant included in the study. 18F-FDG PET/CT showed multiple foci with intensive tracer uptake in both hepatic lobes (A and C—arrows), suggestive of hepatic candidiasis mainly because of the history of previous hepatic candidiasis abscesses (4 months before). However, due to lack of clinical symptoms, intensive 18F-FDG avid lesions under antifungal therapy, borderline serum beta-D-glucan (63 pg/mL), and differential diagnosis of liver metastases of lymphoma, further histological verification was performed. The histopathological findings (hematoxylin and eosin stain) revealed focal fibrosis with proliferating bile ducts, foamy cells, and lymphocytes (G and H), correlating with reactive and resorptive processes following the preexisting hepatic abscesses (E and F). Antifungal treatment with posaconazole 300 mg was continued leading to complete remission of the disease assessed by follow-up 18F-FDG PET/CT after 3 months (B and D). The residual mediastinal mass showed only faint uptake on both 18F-FDG PET/CT studies suggestive of Deauville score 2.

This case presents an unusual pitfall of 18F-FDG PET/CT in assessment of liver disease and emphasizes again on the value of 18F-FDG PET/CT in the detection of invasive fungal infection, a severe infection in the immunocompromised patients, and also its usefulness in assessing response to treatment [1-4].