Altered distribution of technetium-99m sodium pertechnetate associated with antimicrobial therapy

Three patients underwent brain scanning for evaluation of central nervous system disease and were simultaneously treated for infectious diseases unrelated to the central nervous process. All revealed intense vascular pooling on their brain images. The imaging studies had been performed following the administration of Tc-99m pertechnetate. None of the patients had prior nuclear medicine examinations to suggest the causal effect of stannous ion as a source of interference. All of the patients were on combination antimicrobial drugs: two on sulfamethoxazole and trimethoprim, and one on isoniazid and ethambutol. One patient revealed 75% Tc-99m red cell tagging. Another patient's repeat brain scan with Tc-99m DTPA revealed normal distribution. Our findings suggest that patients on antimicrobial combination drug regimens who require brain scans should be imaged routinely with agents other than Tc-99m.