Work

Achilles Tendon Xanthoma Inflammation Revealed by FDG-PET/CT in Familial Hypercholesterolemia

Year: 2026

Type: article

Abstract: BACKGROUND: Achilles tendon xanthomas are hallmark lesions of familial hypercholesterolemia (FH), but their metabolic activity remains poorly characterized. CASE SUMMARY: F-fluorodeoxyglucose (FDG) uptake on positron emission tomography/computed tomography (PET/CT) indicated metabolically active inflammation. In case 2, the man's 71-year-old father, who had been receiving long-term statins (>10 years), ezetimibe (>1 year), and recent proprotein convertase subtilisin/kexin type 9 inhibitor (1 month), had Achilles tendon thickening but no FDG uptake despite age and coronary artery disease history. DISCUSSION: These findings show that xanthomas exhibit persistent metabolic activity despite short-term lipid lowering, whereas prolonged therapy may attenuate inflammation. Phenotypic differences underscore roles of disease stage, cumulative lipid exposure, and treatment duration. FDG-PET/CT provides metabolic information for risk assessment and therapeutic monitoring.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2026.106949

Authors: Takaharu Nakayoshi, Nobuhiro Tahara, Yayoi Sakata, Shuichi Tanoue, Yoshihiro Fukumoto

Institution: Kurume University

Language: English

Topic: Lipoproteins and Cardiovascular Health

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850