First Reported Case of Erasmus Syndrome in Iran: [18F]Fdg Pet/Ct Findings in Silicosis-Associated Systemic Sclerosis Publisher



Cheraghi Z ; Emami Ardekani A ; Chehreghani M
Source: Iranian Journal of Nuclear Medicine Published:2026

Abstract

A 53-year-old man with a 20-year history of occupational silica exposure presented with progressive dyspnea, unexplained weight loss, skin thickening of the fingers, and Raynaud's phenomenon. Initial HRCT findings were consistent with fibrotic interstitial lung disease and calcified mediastinal lymph nodes related to silica exposure. Given the patient's unexplained weight loss, whole-body [18F]FDG PET/CT was performed to exclude occult malignancy. The PET/CT scan demonstrated no evidence of a metabolically active primary tumor or metastatic disease; however, multiple metabolically active pulmonary nodules, fibroreticular parenchymal changes, and calcified mediastinal lymph nodes were identified. Based on the clinical and imaging findings, the patient fulfilled the 2013 ACR/EULAR classification criteria for systemic sclerosis. In the context of the patient's occupational history and clinical features, these findings supported the diagnosis of Erasmus syndrome. A brief review of the literature indicates that, to the best of our knowledge, no cases from Iran have been reported to date. This case underscores the added value of [18F]FDG PET/CT in the differential diagnosis of pulmonary nodules and mediastinal lymphadenopathy, particularly in excluding malignancy and characterizing inflammatory and fibrotic disease activity, thereby facilitating more accurate diagnosis and appropriate therapeutic decision-making in complex occupational and autoimmune lung diseases. Copyright © 2026 The Authors. Published by Tehran University of Medical Sciences. This work is published as an open access article distributed under the terms of the Creative Commons Attribution 4.0 License (http://creativecommons.org/licenses/by-nc/4). Non-commercial uses of the work are permitted, provided the original work is properly cited