Outcome of using PET Imaging as a Diagnostic Tool for Two Patients with Common Variable Immunodeficiency (CVID) and Lymphadenopathy

RATIONALE: Lymphoid hyperplasia, along with a high risk of lymphoma has been reported in CVID patients. PET imaging has been used to differentiate malignant from nonmalignant lymphoid proliferation. METHODS: Chart review of 2 CVID patients with abnormal PET imaging. RESULTS: Patient A: 54-year-old male diagnosed with CVID had a body CT that revealed diffused lymphadenopathy, as well as pulmonary nodules. Follow-up PET imaging revealed extensive chest lymphadenopathy with the greatest uptake in right paratracheal region and left pleural based nodule. Image-guided needle biopsy revealed a polyclonal B-cell population. Subsequent lung wedge and hilar lymph node biopsy revealed no evidence of lymphoma. Patient B: 41-year-old-male diagnosed with CVID underwent a CT angiogram of the abdomen that revealed extensive axillary and mesenteric lymphadenopathy. PET imaging revealed multiple abnormal foci of hypermetabolism, corresponding to bilateral axillary and abdominal adenopathy. A fine needle aspirate of the right axillary lymph node revealed increased reactive lymphoid T cells. Subsequent PET Imaging revealed increase in abnormal foci as well as multiple new foci within the spleen. An excisional biopsy of the right axillary lymph node revealed features suggestive of Hodgkin's lymphoma. CONCLUSION: These two cases exemplify the limited value of PET Imaging in distinguishing lymphoma from atypical lymphadenopathy in patients with CVID and that excisional biopsies should be done with persistently positive PET imaging. These clinical findings also underscore the need to wait 2 years before diagnosing CVID in a patients presenting with hypogammaglobulinemia.