Muscular damage in a patient with hepatitis B induced by beta-l-2'-deoxythymidine and detected by 18F-FDG PET/CT.

A 58 years old man under 2'-Deoxy-L-thymidine treatment for his hepatitis B was admitted to our hospital complaining for the last 2 months of recurrent upper abdomen discomfort, fatigue and weight loss of 10 kilograms and general muscular soreness, for 2 weeks. He had elevated creatine kinase (CK), myoglobin, CK-MB and other related or common laboratory findings. Fluorine-18- fluorodeoxyglucose positron emission tomography/ computed tomography (18F-FDG PET/CT) showed a diffuse, homogenous, moderately elevated glucose uptake in all muscle groups. Muscular damage induced by 2'-Deoxy-L-thymidine was suspected and the drug was discontinued. Muscle soreness and the biomarkers for muscular tissue damage improved. Fluorine-18-FDG PET/CT is useful to rule out malignancy and identify muscular tissue damage.