The role of PET/CT scan in addressing autoinflammatory diseases; A case report of a young man presenting with fever, splenomegaly and exanthem
Adult-onset Still's disease (AOSD) is an uncommon autoinflammatory syndrome characterized by quotidian fever, arthritis, evanescent exanthem and splenomegaly. Lymphadenopathy is present in about a half of patients; it is usually symmetrical with the cervical area being most commonly involved. W...
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| Veröffentlicht in: | Hellenic journal of nuclear medicine 2024-09, Vol.27 (3), p.243 |
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| creator | Geladari, Eleni V Pianou, Nikoletta K Angelis, Nikolaos A Skourou, Anna G Roumpaki, Anastasia G Landrou, Ioannis K Papahristodoulou, Kyriaki A Argirios, Stouras K Marinos, Leonidas D Benakis, Stylianos V Rondogianni, Phoivi E Sevastianos, Vasileios A |
| description | Adult-onset Still's disease (AOSD) is an uncommon autoinflammatory syndrome characterized by quotidian fever, arthritis, evanescent exanthem and splenomegaly. Lymphadenopathy is present in about a half of patients; it is usually symmetrical with the cervical area being most commonly involved. When constitutional symptoms are present, an extensive work-up should be performed in order to exclude hematological malignancies, such as lymphoma.
A 38-year-old male is presented due to fatigue and high-grade fever that first appeared a month ago. He did also refer night sweats, arthralgias and an evanescent erythema on the trunk and anterior thigh area. Serology testing for bacteria and viruses as well as autoimmune rheumatic diseases was requested. Whole body computed tomography (CT) scan was ordered and displayed a marginal lymph node in the right hilum and smaller ones in the axillary region. Positron emission tomography/CT (PET/CT) with fluorine-18-fluoro-deoxy-glucose (
F-FDG) showed hypermetabolic lymph nodes, with the right upper internal jugular lymph node being the most dominant, as well as diffusely increased
F-FDG uptake by bone marrow and spleen, posing in the differential diagnosis a neoplastic disease of the hematopoietic tissues.
Further laboratory testing showed high ferritin levels. It was decided to procced with biopsy of the aforementioned hypermetabolic internal jugular lymph node and bone marrow. Histopathological examination did show hyperreactivity and no malignant cells neither in the lymph node nor in the bone marrow.
Adult-onset Still's disease is a rare disorder and it is a diagnosis of exclusion. High-grade fever along with arthralgias, splenomegaly, high serum ferritin levels and the presence of exanthem should pose high in the differential the AOSD. In this case, PET/CT guided the anatomical location for lymph node biopsy in order to differentiate AOSD from lymphoma. The dissociated increased
F-FDG uptake from the cervical and axillary lymph nodes is characteristic of AOSD. |
| doi_str_mv | 10.1967/s002449912759 |
| format | Article |
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A 38-year-old male is presented due to fatigue and high-grade fever that first appeared a month ago. He did also refer night sweats, arthralgias and an evanescent erythema on the trunk and anterior thigh area. Serology testing for bacteria and viruses as well as autoimmune rheumatic diseases was requested. Whole body computed tomography (CT) scan was ordered and displayed a marginal lymph node in the right hilum and smaller ones in the axillary region. Positron emission tomography/CT (PET/CT) with fluorine-18-fluoro-deoxy-glucose (
F-FDG) showed hypermetabolic lymph nodes, with the right upper internal jugular lymph node being the most dominant, as well as diffusely increased
F-FDG uptake by bone marrow and spleen, posing in the differential diagnosis a neoplastic disease of the hematopoietic tissues.
Further laboratory testing showed high ferritin levels. It was decided to procced with biopsy of the aforementioned hypermetabolic internal jugular lymph node and bone marrow. Histopathological examination did show hyperreactivity and no malignant cells neither in the lymph node nor in the bone marrow.
Adult-onset Still's disease is a rare disorder and it is a diagnosis of exclusion. High-grade fever along with arthralgias, splenomegaly, high serum ferritin levels and the presence of exanthem should pose high in the differential the AOSD. In this case, PET/CT guided the anatomical location for lymph node biopsy in order to differentiate AOSD from lymphoma. The dissociated increased
F-FDG uptake from the cervical and axillary lymph nodes is characteristic of AOSD.</description><identifier>ISSN: 1790-5427</identifier><identifier>DOI: 10.1967/s002449912759</identifier><identifier>PMID: 39644276</identifier><language>eng</language><publisher>Greece</publisher><subject>Adult ; Diagnosis, Differential ; Exanthema - diagnostic imaging ; Fever - diagnostic imaging ; Fluorodeoxyglucose F18 ; Humans ; Male ; Positron Emission Tomography Computed Tomography - methods ; Splenomegaly - diagnostic imaging ; Still's Disease, Adult-Onset - complications ; Still's Disease, Adult-Onset - diagnostic imaging</subject><ispartof>Hellenic journal of nuclear medicine, 2024-09, Vol.27 (3), p.243</ispartof><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39644276$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Geladari, Eleni V</creatorcontrib><creatorcontrib>Pianou, Nikoletta K</creatorcontrib><creatorcontrib>Angelis, Nikolaos A</creatorcontrib><creatorcontrib>Skourou, Anna G</creatorcontrib><creatorcontrib>Roumpaki, Anastasia G</creatorcontrib><creatorcontrib>Landrou, Ioannis K</creatorcontrib><creatorcontrib>Papahristodoulou, Kyriaki A</creatorcontrib><creatorcontrib>Argirios, Stouras K</creatorcontrib><creatorcontrib>Marinos, Leonidas D</creatorcontrib><creatorcontrib>Benakis, Stylianos V</creatorcontrib><creatorcontrib>Rondogianni, Phoivi E</creatorcontrib><creatorcontrib>Sevastianos, Vasileios A</creatorcontrib><title>The role of PET/CT scan in addressing autoinflammatory diseases; A case report of a young man presenting with fever, splenomegaly and exanthem</title><title>Hellenic journal of nuclear medicine</title><addtitle>Hell J Nucl Med</addtitle><description>Adult-onset Still's disease (AOSD) is an uncommon autoinflammatory syndrome characterized by quotidian fever, arthritis, evanescent exanthem and splenomegaly. Lymphadenopathy is present in about a half of patients; it is usually symmetrical with the cervical area being most commonly involved. When constitutional symptoms are present, an extensive work-up should be performed in order to exclude hematological malignancies, such as lymphoma.
A 38-year-old male is presented due to fatigue and high-grade fever that first appeared a month ago. He did also refer night sweats, arthralgias and an evanescent erythema on the trunk and anterior thigh area. Serology testing for bacteria and viruses as well as autoimmune rheumatic diseases was requested. Whole body computed tomography (CT) scan was ordered and displayed a marginal lymph node in the right hilum and smaller ones in the axillary region. Positron emission tomography/CT (PET/CT) with fluorine-18-fluoro-deoxy-glucose (
F-FDG) showed hypermetabolic lymph nodes, with the right upper internal jugular lymph node being the most dominant, as well as diffusely increased
F-FDG uptake by bone marrow and spleen, posing in the differential diagnosis a neoplastic disease of the hematopoietic tissues.
Further laboratory testing showed high ferritin levels. It was decided to procced with biopsy of the aforementioned hypermetabolic internal jugular lymph node and bone marrow. Histopathological examination did show hyperreactivity and no malignant cells neither in the lymph node nor in the bone marrow.
Adult-onset Still's disease is a rare disorder and it is a diagnosis of exclusion. High-grade fever along with arthralgias, splenomegaly, high serum ferritin levels and the presence of exanthem should pose high in the differential the AOSD. In this case, PET/CT guided the anatomical location for lymph node biopsy in order to differentiate AOSD from lymphoma. The dissociated increased
F-FDG uptake from the cervical and axillary lymph nodes is characteristic of AOSD.</description><subject>Adult</subject><subject>Diagnosis, Differential</subject><subject>Exanthema - diagnostic imaging</subject><subject>Fever - diagnostic imaging</subject><subject>Fluorodeoxyglucose F18</subject><subject>Humans</subject><subject>Male</subject><subject>Positron Emission Tomography Computed Tomography - methods</subject><subject>Splenomegaly - diagnostic imaging</subject><subject>Still's Disease, Adult-Onset - complications</subject><subject>Still's Disease, Adult-Onset - diagnostic imaging</subject><issn>1790-5427</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo10D1PwzAQBmAPIFoKIyvyyEDBSfwRi6mqyodUCYbs0SW-tEGJHewEyJ_gN5OKMt3p9L7PcIRcRewu0lLdB8ZizrWOYiX0CZlHSrOl4LGakfMQ3hkTUsn0jMwSLfl0lnPyk-2RetcgdRV922T364yGEiytLQVjPIZQ2x2FoXe1rRpoW-idH6mpA0LA8EBXtJwW6rFzvj8oQEc3TJ12UroJQNsfiK-639MKP9Hf0tA1aF2LO2hGCtZQ_Abb77G9IKcVNAEvj3NBssdNtn5ebl-fXtar7bITUi7jSKEsqhJ4ogyXseZcGeAiKUAhpEUKGFe60AAxZ1rIFI1JVZWWjBkRpTxZkJs_tvPuY8DQ520dSmwasOiGkCcRl0JqqdMpen2MDkWLJu983YIf8_8XJr-zPnKp</recordid><startdate>202409</startdate><enddate>202409</enddate><creator>Geladari, Eleni V</creator><creator>Pianou, Nikoletta K</creator><creator>Angelis, Nikolaos A</creator><creator>Skourou, Anna G</creator><creator>Roumpaki, Anastasia G</creator><creator>Landrou, Ioannis K</creator><creator>Papahristodoulou, Kyriaki A</creator><creator>Argirios, Stouras K</creator><creator>Marinos, Leonidas D</creator><creator>Benakis, Stylianos V</creator><creator>Rondogianni, Phoivi E</creator><creator>Sevastianos, Vasileios A</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>202409</creationdate><title>The role of PET/CT scan in addressing autoinflammatory diseases; A case report of a young man presenting with fever, splenomegaly and exanthem</title><author>Geladari, Eleni V ; Pianou, Nikoletta K ; Angelis, Nikolaos A ; Skourou, Anna G ; Roumpaki, Anastasia G ; Landrou, Ioannis K ; Papahristodoulou, Kyriaki A ; Argirios, Stouras K ; Marinos, Leonidas D ; Benakis, Stylianos V ; Rondogianni, Phoivi E ; Sevastianos, Vasileios A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p566-217e6bfca437d4629447da453ba7ea8b8ae2f9b9aa2409568edd87f8c00d51843</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Diagnosis, Differential</topic><topic>Exanthema - diagnostic imaging</topic><topic>Fever - diagnostic imaging</topic><topic>Fluorodeoxyglucose F18</topic><topic>Humans</topic><topic>Male</topic><topic>Positron Emission Tomography Computed Tomography - methods</topic><topic>Splenomegaly - diagnostic imaging</topic><topic>Still's Disease, Adult-Onset - complications</topic><topic>Still's Disease, Adult-Onset - diagnostic imaging</topic><toplevel>online_resources</toplevel><creatorcontrib>Geladari, Eleni V</creatorcontrib><creatorcontrib>Pianou, Nikoletta K</creatorcontrib><creatorcontrib>Angelis, Nikolaos A</creatorcontrib><creatorcontrib>Skourou, Anna G</creatorcontrib><creatorcontrib>Roumpaki, Anastasia G</creatorcontrib><creatorcontrib>Landrou, Ioannis K</creatorcontrib><creatorcontrib>Papahristodoulou, Kyriaki A</creatorcontrib><creatorcontrib>Argirios, Stouras K</creatorcontrib><creatorcontrib>Marinos, Leonidas D</creatorcontrib><creatorcontrib>Benakis, Stylianos V</creatorcontrib><creatorcontrib>Rondogianni, Phoivi E</creatorcontrib><creatorcontrib>Sevastianos, Vasileios A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Hellenic journal of nuclear medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Geladari, Eleni V</au><au>Pianou, Nikoletta K</au><au>Angelis, Nikolaos A</au><au>Skourou, Anna G</au><au>Roumpaki, Anastasia G</au><au>Landrou, Ioannis K</au><au>Papahristodoulou, Kyriaki A</au><au>Argirios, Stouras K</au><au>Marinos, Leonidas D</au><au>Benakis, Stylianos V</au><au>Rondogianni, Phoivi E</au><au>Sevastianos, Vasileios A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The role of PET/CT scan in addressing autoinflammatory diseases; A case report of a young man presenting with fever, splenomegaly and exanthem</atitle><jtitle>Hellenic journal of nuclear medicine</jtitle><addtitle>Hell J Nucl Med</addtitle><date>2024-09</date><risdate>2024</risdate><volume>27</volume><issue>3</issue><spage>243</spage><pages>243-</pages><issn>1790-5427</issn><abstract>Adult-onset Still's disease (AOSD) is an uncommon autoinflammatory syndrome characterized by quotidian fever, arthritis, evanescent exanthem and splenomegaly. Lymphadenopathy is present in about a half of patients; it is usually symmetrical with the cervical area being most commonly involved. When constitutional symptoms are present, an extensive work-up should be performed in order to exclude hematological malignancies, such as lymphoma.
A 38-year-old male is presented due to fatigue and high-grade fever that first appeared a month ago. He did also refer night sweats, arthralgias and an evanescent erythema on the trunk and anterior thigh area. Serology testing for bacteria and viruses as well as autoimmune rheumatic diseases was requested. Whole body computed tomography (CT) scan was ordered and displayed a marginal lymph node in the right hilum and smaller ones in the axillary region. Positron emission tomography/CT (PET/CT) with fluorine-18-fluoro-deoxy-glucose (
F-FDG) showed hypermetabolic lymph nodes, with the right upper internal jugular lymph node being the most dominant, as well as diffusely increased
F-FDG uptake by bone marrow and spleen, posing in the differential diagnosis a neoplastic disease of the hematopoietic tissues.
Further laboratory testing showed high ferritin levels. It was decided to procced with biopsy of the aforementioned hypermetabolic internal jugular lymph node and bone marrow. Histopathological examination did show hyperreactivity and no malignant cells neither in the lymph node nor in the bone marrow.
Adult-onset Still's disease is a rare disorder and it is a diagnosis of exclusion. High-grade fever along with arthralgias, splenomegaly, high serum ferritin levels and the presence of exanthem should pose high in the differential the AOSD. In this case, PET/CT guided the anatomical location for lymph node biopsy in order to differentiate AOSD from lymphoma. The dissociated increased
F-FDG uptake from the cervical and axillary lymph nodes is characteristic of AOSD.</abstract><cop>Greece</cop><pmid>39644276</pmid><doi>10.1967/s002449912759</doi></addata></record> |
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| ispartof | Hellenic journal of nuclear medicine, 2024-09, Vol.27 (3), p.243 |
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| source | MEDLINE; Alma/SFX Local Collection; EZB Electronic Journals Library |
| subjects | Adult Diagnosis, Differential Exanthema - diagnostic imaging Fever - diagnostic imaging Fluorodeoxyglucose F18 Humans Male Positron Emission Tomography Computed Tomography - methods Splenomegaly - diagnostic imaging Still's Disease, Adult-Onset - complications Still's Disease, Adult-Onset - diagnostic imaging |
| title | The role of PET/CT scan in addressing autoinflammatory diseases; A case report of a young man presenting with fever, splenomegaly and exanthem |
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