challenging results on fdg pet/ct in a patient with uncontrolled celiac disease and small bowel adenocarcinoma

Celiac disease (cd) is a chronic immune-mediated enteropathy that is caused by both environmental (gluten) and genetic (human leukocyte antigen (hla) and non-hla genes) factors. patients may be asymptomatic or exhibit atypical symptoms, necessitating a high index of suspicion for proper diagnosis. the evaluation of cd patients with 18f-fdg pet/ct imaging can be difficult, owing to the fact that this disease is inflammatory in nature. typical 18f-fdg pet/ct gastrointestinal manifestations of celiac disease include increased multifocal or diffuse bowel uptake, whereas single short segmental uptake is rarely encountered; thus, awareness of this wide range of findings is important to guide physicians through proper management and outcome. we report a case of small intestine adenocarcinoma and known cd complaining of recent episodes of diarrhea and weight loss that had a suspicious small bowel wall thickening that corresponds to a short segmental hypermetabolic process on fdg pet/ct follow-up scan. the patient was then referred to the gastroenterology department and underwent a colonoscopy, a biopsy was taken that revealed cd and was negative for malignancy. furthermore, 6 months later the abovementioned segmental fdg activity was completely resolved without any treatment received at the given time.