PMC4746846_01
Maximum intensity projection fluoro-D-glucose positron emission tomography/computed tomography image demonstrated multifocal fluoro-D-glucose avid generalized lymphadenopathy (maximum standardized uptake value 13.8) with the pattern of hypermetabolic lesions mimicking lymphoma
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F1
Suspecting it to be metastatic disease, a whole body F-18 FDG PET/CT was performed which showed metabolically active cervical, mediastinal, abdominal, pelvic, left inguinal and femoral lymph nodes [Figure 1].
Lymph node fine needle aspiration cytology showing Ziehl-Neelsen staining, strongly positive for acid-fast bacilli
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F2
FDG uptake is not typical for squamous carcinoma for head and neck metastasis and so it raised the possibility of lymphoma. FNAC showed the Ziehl-Neelsen staining to be strongly positive for acid-fast bacilli [Figure 2].
Maximum intensity projection fluoro-D-glucose positron emission tomography/computed tomography showing remarkable improvement of disease after 6 months of anti-tubercular treatment, with residual hypermetabolism noted at right cervical level I, right paratracheal, and right axillary lymph nodes after the treatment
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F3
Six months later after the initiation of therapy, a follow-up whole body F18-FDG PET/CT scan showed a significant resolution of previously FDG avid lymph nodes but for residual hypermetabolism at right cervical level I, right paratracheal and right axillary lymph nodes [Figure 3].