Lupus Lymphadenitis With Intense Pentixafor Avidity But Absent FDG Uptake

A 33-year-old woman presented with intermittent fever for 1 month, accompanied by pancytopenia and multiple enlarged lymph nodes in the bilateral neck, axillary and para-iliac regions on ultrasound. With informed consent, the patient was enrolled in a clinical trial comparing 18 F-FDG and 68 Ga-Pentixafor PET/CT for lymph node lesions. In contrast to the negative 18 F-FDG PET/CT findings, 68 Ga-Pentixafor PET/CT showed high tracer uptake in these lymph nodes. Subsequent cervical lymph node excision biopsy revealed reactive lymphoid hyperplasia; combined with elevated anti-ds-DNA, anti-SS-A, and anti-RNP titers, lupus lymphadenitis was diagnosed. After antisystemic lupus erythematosus therapy, the lymph nodes regressed significantly.