Increased FDG uptake in bilateral adrenal tuberculosis appearing like malignancy

A case of isolated bilateral adrenal tuberculosis is presented. A 49-year-old man was admitted to the hospital due to fatigue, progressive anorexia accompanied with nausea and vomiting, weight loss, and pigmentation. Ultrasound and CT showed soft tissue masses in bilateral adrenal glands. Whole-body FDG PET-CT showed bilateral adrenal masses with increased FDG uptake. These unique manifestations indicated that the masses were primary malignancies or tuberculosis. MRI demonstrated irregular low signal intensity in the left adrenal mass on T2WI, which suggested tuberculosis, and histopathology confirmed the diagnosis. This uncommon case underscores the necessity of keeping adrenal tuberculosis in mind as a possible differential diagnosis in bilateral adrenal masses.