False positive 18F-FDG PET/CT due to active varicella zoster infection in a Hodgkin’s lymphoma patient

Document Type : Case Report


1 Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Nuclear Medicine and Molecular Imaging Department, Imam Reza International University, Mashhad, Iran


We report a case of Hodgkin lymphoma (classic type) referred for response assessment after two cycles of chemotherapy with ABVD regiment. The F-18 fluorodeoxyglucose positron emission tomography (F-18 FDG PET/CT) showed hypermetabolic cutaneous and subcutaneous lesions with a linear pattern in the left arm with significant F-18 fluorodeoxyglucose positron accumulation in associate with left axillary hypermetabolic lymph nodes. She presented with left arm pruritic rash accomplished by pain from two weeks ago. On clinical examination, painful papulovesicular rash with palpable enlarged axillary lymph node were noted. These findings were compatible with cutaneous herpes zoster infection of the left arm along with axillary reactive lymphadenopathy.


Main Subjects

  1. Sharma R, Jaimini A, Mondal A, Tripathi M. Pitfall of 18F-FDG-PET imaging in oncology: herpes zoster with axillary lymphadenopathy. Hell J Nucl Med. 2008 Jan-Apr;11(1):51-2.
  2. Sheehy N, Israel DA. Acute varicella infection mimics recurrent Hodgkin's disease on F-18 FDG PET/CT. Clin Nucl Med. 2007 Oct;32(10):820-1.
  3. Muzaffar R, Fesler M, Osman MM. Active shingles infection as detected on (18)F-FDG PET/CT. Front Oncol. 2013 Apr 24;3:103.
  4. Gallamini A, Zwarthoed C. Interim FDG-PET Imaging in Lymphoma. Semin Nucl Med. 2018 Jan;48(1):17-27.
  5. Evens AM, Kostakoglu L. The role of FDG-PET in defining prognosis of Hodgkin lymphoma for early-stage disease. Blood. 2014;124(23):3356-64.
  6. Radford J, Illidge T, Counsell N, Hancock B, Pettengell R, Johnson P, Wimperis J, Culligan D, Popova B, Smith P, McMillan A, Brownell A, Kruger A, Lister A, Hoskin P, O'Doherty M, Barrington S. Results of a trial of PET-directed therapy for early-stage Hodgkin's lymphoma. N Engl J Med. 2015 Apr 23;372(17):1598-607.
  7. Barrington SF, Mikhaeel NG. PET Scans for Staging and Restaging in Diffuse Large B-Cell and Follicular Lymphomas. Curr Hematol Malig Rep. 2016 Jun;11(3):185-95.
  8. Kim KS. Primary nasopharyngeal tuberculosis mimicking carcinoma: a potentially false-positive PET/CT finding. Clin Nucl Med. 2010 May;35(5):346-8.
  9. Williams G, Joyce RM, Parker JA. False-positive axillary lymph node on FDG-PET/CT scan resulting from immunization. Clin Nucl Med. 2006;31(11):731-732.
  10. Hornreich G, Schloss C, Hoskins WJ, Muggia FM. Doxil-induced radiation recall: a cause for false-positive PET scan findings. Gynecol Oncol. 2001 Mar;80(3):422-3.
  11. Paschali AN, Gnanasegaran G, Cook GJ. FDG PET-CT: Need for vigilance in patients treated with bleomycin. Indian J Nucl Med. 2017 Apr-Jun;32(2):122-124.
  12. Corrigan AJ, Schleyer PJ, Cook GJ. Pitfalls and artifacts in the use of PET/CT in oncology imaging. Semin Nucl Med. 2015 Nov;45(6):481-99.
  13. Gorospe Sarasua L, Echeveste Aizpurua J, Raman S. Positron-emission tomography/computed tomography: artifacts and pitfalls in cancer patients. Radiologia. 2006;48(4):189-204.
  14. Keon TP. Death on induction of anesthesia for cervical node biopsy. Anesthesiology. 1981 Oct;55(4):471-2.
  15. Kubota R, Kubota K, Yamada S, Tada M, Ido T, Tamahashi N. Active and passive mechanisms of [fluorine-18] fluorodeoxyglucose uptake by proliferating and prenecrotic cancer cells in vivo: a microautoradiographic study. J Nucl Med. 1994 Jun;35(6):1067-75.
  16. Long NM, Smith CS. Causes and imaging features of false positives and false negatives on F-PET/CT in oncologic imaging. Insights Imaging. 2011 Dec;2(6):679-698.
  17. Strauss LG. Fluorine-18 deoxyglucose and false-positive results: a major problem in the diagnostics of oncological patients. Eur J Nucl Med. 1996 Oct;23(10):1409-15.