播散性隐球菌病在PET/CT上表现类似淋巴瘤一例

A Case of Disseminated Cryptococcosis Resembling Lymphoma on PET/CT

摘要: 目的：通过回顾罕见的发生于免疫功能正常患者的播散性隐球菌病案例，提高临床医生对播散性隐球菌病的认识，帮助临床今后处理类似的病人。方法：回顾分析一例主诉为腰背痛伴活动受限的中年女性患者，临床最初怀疑癌症、18F-FDG PET/CT提示淋巴瘤可能，但最终经病理证实为隐球菌感染。结果：PET/CT显示全身多发高代谢肿大淋巴结并第十胸椎骨质破坏、代谢异常增高，提示淋巴瘤可能。但随后的胸椎活检证实为隐球菌感染，血清隐球菌抗原试验呈阳性，且患者抗真菌治疗后病情明显好转。结论：播散性隐球菌病与淋巴瘤在¹⁸F-FDG PET/CT上有时难以区分，尤其是当患者均表现为全身多发高代谢肿大淋巴结时。PET/CT显像全身成像在显示病变范围和评估疗效方面具有显著优势，并且能够精确指导临床在合适部位进行活检。

Abstract: Objective: By reviewing a rare case of disseminated cryptococcosis occurring in immunocompetent patients, we hope to increase clinicians’ awareness of disseminated cryptococcosis and help clini-cians manage similar cases in the future. Methods: We retrospectively analyzed a case of a mid-dle-aged female patient who complained of back pain and activity limitation. While the patient was initially suspected of having cancer by the clinicians and ¹⁸F-FDG PET/CT suggested the possibility of lymphoma, the biopsies confirmed the diagnosis of disseminated cryptococcosis eventually. Results: PET/CT images demonstrated multiple enlarged lymph nodes and osteolytic changes in the tenth thoracic vertebra with abnormal uptake, indicating the possibility of lymphoma. But the following bone biopsies confirmed the diagnosis of disseminated cryptococcosis with a positive serum cryp-tococcal antigen test, and the patient’s condition improved significantly with antifungal therapy. Conclusion: Disseminated cryptococcosis is sometimes indistinguishable from lymphoma on 18F-FDG PET/CT, especially when patients present with multiple hypermetabolically enlarged lymph nodes throughout the body. The whole-body imaging of PET/CT is useful in assessing the involvement of the disease and evaluating treatment effects, as well as guiding clinical biopsies.