A 52-year-old man, who was treated with antitubercular drugs for
1 year without any benefit for an initial diagnosis of tuberculosis, and was
referred for further evaluation. An FDG-PET study was performed to
evaluate the whole-body disease status, which showed multiple abnormal
foci in bilateral neck nodes, mediastinal, axillary, and multiple abdominal
(para-aortic and inguinal) nodes, and the liver, spleen, and thyroid. A
rebiopsy of the inguinal nodes for a definitive diagnosis was confirmatory of
sarcoidosis. He had a history of hypothyroidism, which is a frequent
accompaniment of sarcoidosis due to the association of autoimmunity in
this population. He was treated with oral corticosteroids and was referred for
reassessment of his disease status with FDG-PET following 6 weeks of
therapy. The FDG-PET images showed remarkable improvement with near
total resolution of the FDG hypermetabolism at the initially involved sites.
The present case underscores the value of FDG-PET imaging in whole-body
monitoring of early response to therapy in patients of sarcoidosis (particularly
those with extensive disease) that can be of substantial benefit and
indicates the promise of this powerful molecular imaging technique in
managing this multisystem disorder.
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