18F-FDG-PET/CT findings in a patient with tuberculosis Hodgkin's disease and lupus vulgaris.

To the Editor: Tuberculosis (TB) has been extensively described in association with various malignancies, especially Hodgkin’s disease (HD) [1]. When TB is accompanying malignant lymphomas is often characterized by an atypical clinical course, with unusual extrapulmonary localizations [2]. Clinical forms of cutaneous TB have been described: These are: the primary TB inoculation, lupus vulgaris (LV), TB verrucosa cutis, scrofuloderma, orofacial TB and miliary TB [1, 3, 4]. A common form of cutaneous TB is LV [4]. Fluorine-18 fluorodeoxyglucose (18F-FDG) whole-body PET scanning has been used for monitoring disseminated TB [5, 6]. 18F-FDG accumulates not only in malignant tumors but also in inflammatory lesions of both infectious and non-infectious origins [7]. We present the18F-FDG-PET/CT findings in a case of HD who also developed LV lesions after chemotherapy. A 25 years old man with a history of mediastinal lymphadenopathy that was diagnosed as HD 11 months ago, received 6 cycles of chemotherapy with adriamycin, bleomycin, vinblastine and dacarbazine. The last chemotherapy treatment was 20 days before he was examined by a 18F-FDG-PET/ CT scan. One month ago he was clinically diagnosed as having LV with granulomatous and ulcerative lesions on left hand and the right pretibial region and received anti-TB treatment with isoniazid, rifampin and ethambutol for one month. The scan was performed from the thighs to the skull base. There were nodular lesions of slightly increased 18F-FDG uptake at the lower parenchymal zones of both lungs, which did not reach the form of typical malignancy but were compatible with inflammatory lesions. Increased 18F-FDG uptake was also detected on bilateral inguinal lymphadenopathy. There was no pathologic uptake on cervical, mediastinal, axillary and intraabdominal lymph notes bilaterally. Increased uptake with cutaneous and subcutaneous hypermetabolic lesions was detected on the left hand (Fig. 1), and on the right leg zones referring to the LV lesions (Fig. 2). 18F-FDG-PET/CT findings in a patient with tuberculosis Hodgkin’s disease and lupus vulgaris