AIDS-Related Central Nervous System Toxoplasmosis With Increased 18F-Fluoroethyl-L-Tyrosine Amino Acid PET Uptake Due to LAT1/2 Expression of Inflammatory Cells

Clin Nucl Med. 2017 Dec;42(12):e506-e508. doi: 10.1097/RLU.0000000000001873.

Abstract

We report the case of a 40-year-old woman with a progressive right-sided hemiparesis. Standard MRI revealed a contrast-enhancing brain lesion within the left basal ganglia. Ffluoroethyl-L-tyrosine (F-FET) PET showed a distinct tracer uptake (lesion-to-brain ratio [LBR]: LBRmax = 2.03, LBRmean = 1.68) with a significant larger metabolic lesion volume than contrast-enhancement in MRI, indicating cerebral glioma. Surprisingly, histopathologic analysis demonstrated central nervous system toxoplasmosis with pronounced inflammatory reaction (reactive astrogliosis, microglia activation, macrophage, and T-lymphocyte infiltration), which was associated with strong LAT1/LAT2/CD98 expression. In conclusion, inflammatory brain lesions, such as cerebral toxoplasmosis, represent a potential pitfall of F-FET PET mimicking a brain tumor.

Publication types

  • Case Reports

MeSH terms

  • Acquired Immunodeficiency Syndrome / complications*
  • Adaptor Proteins, Signal Transducing / metabolism*
  • Adult
  • Biological Transport
  • Brain Neoplasms / diagnostic imaging
  • Diagnosis, Differential
  • Female
  • Gene Expression Regulation*
  • Humans
  • Inflammation / pathology
  • Large Neutral Amino Acid-Transporter 1 / metabolism*
  • Positron-Emission Tomography*
  • Toxoplasmosis, Cerebral / complications
  • Toxoplasmosis, Cerebral / diagnostic imaging*
  • Toxoplasmosis, Cerebral / metabolism
  • Tyrosine / analogs & derivatives*
  • Tyrosine / metabolism

Substances

  • Adaptor Proteins, Signal Transducing
  • LAT2 protein, human
  • Large Neutral Amino Acid-Transporter 1
  • (18F)fluoroethyltyrosine
  • Tyrosine