incidentally detected celiac disease with splenomegaly on 18f fdg pet/ct: a potential lymphoma mimic

Celiac disease is an immune-mediated disorder triggered by hypersensitivity to gluten occurring in genetically susceptible individuals. a high-index of suspicion is needed for diagnosis as patients can be asymptomatic or present with atypical symptoms or extra-intestinal manifestations. typical 18f-fluorodeoxyglucose (fdg) positron emission tomography (pet)/computed tomography (ct) gastrointestinal manifestations of celiac disease include increased multifocal or diffuse jejunal and ileal uptake; focal duodenal uptake is less common. splenomegaly with increased splenic fdg uptake is also uncommon in celiac disease in the absence of portal hypertension; small-sized spleen and functional hyposplenism are more typical. we report a case of celiac disease diagnosed after pet/ct showed fdg uptake in the duodenum and enlarged spleen. follow-up after gluten-free diet showed complete metabolic resolution and regression of splenomegaly. the combination of focal bowel and splenic uptake is unusual in celiac disease and may be mistaken for a lymphoproliferative disorder. awareness of this entity may avoid misdiagnosis and guide appropriate management.