case_images: PMC4746846_01
case_images: 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
case_images: IJNM-31-59-g001.jpg
case_images: PMC4746846_01_IJNM-31-59-g001.jpg
case_images: F1
case_images: 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].
case_images: Lymph node fine needle aspiration cytology showing Ziehl-Neelsen staining, strongly positive for acid-fast bacilli
case_images: IJNM-31-59-g002.jpg
case_images: PMC4746846_01_IJNM-31-59-g002.jpg
case_images: F2
case_images: 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].
case_images: 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
case_images: IJNM-31-59-g003.jpg
case_images: PMC4746846_01_IJNM-31-59-g003.jpg
case_images: F3
case_images: 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].