Pelvic inflammatory disease with Tc-99m ciprofloxacin imaging

The clinical diagnosis of pelvic inflammatory disease (PID) is inexact. There are multiple potential symptoms and signs ascribable to PID as predicted by areas of inflammatory involvement. No symptoms or signs are pathognomonic for PID. The authors describe single photon emission computed tomography (SPECT) images of technetium-99m ((99m)Tc) ciprofloxacin imaging of patients with PID that showed foci of significantly increased uptake in the regions corresponding to the areas of clinical symptoms. We report two such cases of PID. We undertook physical exams, complete blood count, erythrocyte sedimentation rate, C-reactive protein, Gram stains, wet smears, cultures, Mycoplasma genetic studies, Chlamydia cultures, and SPECT before treatment. During treatment we took laparoscopies, hysteroscopies, biopsies, and cultures. After the treatment, we repeated the same exams. (99m)Tc ciprofloxacin imaging is considered valuable in persons with symptoms of PID in whom diagnosis is difficult.