Candida esophagitis incidentally detected by 18F‐FDG PET/CT in a patient with CNS lymphoma

Abstract

Corticosteroids are commonly used in lymphoma patients, and findings in favor of esophageal involvement in 18F‐FDG PET‐CT should be considered suspicious and definitely be confirmed by biopsy. We describe a 58‐year‐old lady with diffuse large B‐cell lymphoma and central nervous system involvement having an increased metabolism in the distal esophagus with 18F‐FDG PET/CT, which was consistent with esophageal candidiasis, most probably due to prolonged use of dexamethasone. Esophageal candidiasis can be misdiagnosed as malignancy with a high SUVmax and may lead to difficulties while managing these patients.

Clinical significance of incidental 18FDG PET uptake in the gastrointestinal tract: a retrospective cohort study

“…There are limited data on the endoscopic assessment of incidental upper gastrointestinal PET uptake. Published cases of unexpected upper gastrointestinal PET uptake have been associated with endoscopic findings of Barrett's oesophagus, Helicobacter pylori ‐associated gastritis, Candida oesophagitis and gastric adenocarcinoma 13–17 . Previous retrospective studies evaluating incidental PET uptake in the upper GIT have found new malignancies in up to 25% of cases; however, these have been over a small time period of 2 years 18,19 .…”

“…Published cases of unexpected upper gastrointestinal PET uptake have been associated with endoscopic findings of Barrett's oesophagus, Helicobacter pylori-associated gastritis, Candida oesophagitis and gastric adenocarcinoma. [13][14][15][16][17] Previous retrospective studies evaluating incidental PET uptake in the upper GIT have found new malignancies in up to 25% of cases; however, these have been over a small time period of 2 years. 18,19 One of these studies only had data from endoscopic assessment available in 70% of the eligible patients.…”

Elevated FAPI Activity in Ulcerative Fungal Esophagitis

“…Fungal esophagitis is an ulcerative pseudomembranous inflammation of the esophagus caused by fungal invasion of the esophageal mucosa 1 . Fungal esophagitis with increased 18 F-FDG uptake has been reported previously 2–5 . Elevated 68 Ga-FAPI avidity was found in a variety of tumors, 6 as well as in cancerous ulcers of esophageal cancer 7 .…”

“…1 Fungal esophagitis with increased 18 F-FDG uptake has been reported previously. [2][3][4][5] Elevated 68 Ga-FAPI avidity was found in a variety of tumors, 6 as well as in cancerous ulcers of esophageal cancer. 7 In this case, when fungal esophagitis is complicated by ulceration, it can also present increased FAPI activity.…”