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68Ga-Prostate-Specific Membrane Antigen Uptake in Cerebral Tuberculosis
Veronica Chi Ken Wong, Lily Shen1, Elias Nasser
1From the Department of Nuclear medicine and PET, Nepean Hospital, Kingswood.
Clinical Nuclear Medicine
|January 25, 2020
Summary
A man with prostate cancer developed brain lesions that mimicked metastases. However, further testing revealed a rare case of brain infection caused by mycobacterium tuberculosis, which was PSMA-avid.
Area of Science:
- Nuclear medicine imaging
- Infectious disease diagnostics
- Oncology
Background:
- A 71-year-old male with high-risk prostate adenocarcinoma (Gleason score 9) treated with brachytherapy presented with a rising PSA.
- The patient underwent Gallium-68 (Ga) prostate-specific membrane antigen (PSMA)-HBED-CC PET/CT for suspected prostate cancer recurrence.
Observation:
- The PET/CT scan revealed PSMA-avid, dura-based hyperdense lesions in the brain.
- These lesions were initially suggestive of cerebral metastases from prostate cancer.
Findings:
- Biopsy of the brain lesions identified acid-fast bacilli.
- Subsequent clinical and microbiological testing confirmed a diagnosis of PSMA-avid cerebral tuberculous mycobacterium infection.
Implications:
- This case highlights the potential for tuberculous mycobacterium infections to exhibit PSMA avidity.
- It underscores the importance of considering infectious etiologies in PSMA-avid brain lesions, even in cancer patients.
- Accurate diagnosis is crucial to avoid misinterpreting infection as metastatic disease, ensuring appropriate treatment.
