A 14-year-old male from a rural community presented with a 4-week history of loose stools and recent lower respiratory tract infection. Initial investigations revealed elevated inflammatory and liver markers (CRP 100 mg/L, ALT 90 U/L, ALP 586 U/L), thrombocytosis (661 × 10^9/L), anemia (Hgb 74 g/L), and hypoalbuminemia (21 g/L). Ultrasound demonstrated a “starry sky” liver and gallbladder sludge. CT of the chest, abdomen, and pelvis showed multiple bilateral pulmonary nodules, small pleural effusions, mild colitis, and enlarged mesenteric and periportal lymph nodes, initially raising concern for metastatic disease. PET/CT revealed FDG-avid pulmonary nodules and lymph nodes near the pancreatic head and tail. MRI/MRCP confirmed nodal conglomerates in these regions without a discrete pancreatic lesion. Testicular ultrasound was normal. There were no superficial FDG-avid lymph nodes available for biopsy. Laparoscopic resection of the pancreatic tail lymph node conglomerate was considered but not pursued as the patient began to improve clinically and biochemically. Infectious and autoimmune workup was largely negative except for a low-titre positive ANA (polar/Golgi-like pattern, 1:80). IgG subclass testing showed isolated IgG1 elevation (IgG4 negative). No specific infectious or malignant etiology was identified. The patient’s condition improved spontaneously within three weeks, with normalization of inflammatory and liver parameters and interval reduction of lymphadenopathy on follow-up imaging. This case highlights a self-limiting multisystem inflammatory process that radiologically mimicked disseminated malignancy. Knowledge of transient self-limiting autoinflammatory syndromes should be considered to prevent unnecessary invasive investigations or treatments. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Hopkins Erin, James Anna, Hayward Mark

Keywords: Autoinflammation, FDG PET, Lymphadenopathy