Early detection of disseminated tuberculosis after cord blood transplantation: role of pre-transplant positron emission tomography

Abstract

 18F-fluorodeoxyglucose-positron emission tomography (PET) is a useful asset for evaluating the disease stage, residual disease, and activity of malignant lymphoma, including adult T-cell leukemia/lymphoma (ATLL), and its use to treat infectious diseases has also been reported. After a 51-year-old female with ATLL received chemotherapy, all of her lesions became undetectable by computed tomography (CT). However, intrathoracic lymph nodes were found to be PET-avid without significant swelling, and were considered recurrent ATLL lesions. She subsequently underwent cord blood transplantation (CBT). Two months later, she presented with high-grade fever. CT revealed significant left hilar and mediastinal lymph node swelling with central low density, suggesting necrosis. After Mycobacterium tuberculosis (M. tuberculosis) was repeatedly detected in her blood, urine, feces, and gastric juice, disseminated tuberculosis was diagnosed. Physicians should always be aware of infectious diseases, particularly tuberculosis, as a possible cause of PET-avid nodal lesions in immunocompromised patients.