18-Fluorine-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in the Evaluation of the Great Masquerader Melioidosis: A Case Series
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Published on: September 5, 2017
Pramukh Kulkarni1, Simon Shelley1, Indirani M Elangoven1
1Department of Nuclear Medicine and PET-CT, Apollo Hospitals, Chennai, Tamil Nadu, India.
Abstract:
Melioidosis is an emerging infectious disease in India. The disease has a crippling effect on the patient owing to its widespread dissemination and complications post bacteremia. The role of 18-fluorine-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) is becoming increasingly important in terms of documenting the extent of disease and response to treatment. Herein, we present cases of two patients who were referred for a whole-body 18F-FDG PET-CT scan with a history of long-standing fever that went undiagnosed. 18F-FDG PET-CT scan was performed to evaluate pyrexia of unknown origin. A conclusion was reached after blood culture which showed the growth of Burkholderia pseudomallei - which is considered to be the cause of this rare but debilitating disease.
Insights
Melioidosis, a severe infectious disease in India, can be diagnosed using 18-fluorine-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT). This imaging technique helps document disease extent and treatment response in patients with fever of unknown origin.
Area of Science:
- Infectious Diseases
- Medical Imaging
- Microbiology
Background:
- Melioidosis is an emerging infectious disease in India with significant morbidity due to disseminated infections and post-bacteremia complications.
- Diagnosing Melioidosis, caused by *Burkholderia pseudomallei*, can be challenging, especially in cases presenting as pyrexia of unknown origin.
- Whole-body 18-fluorine-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) is increasingly utilized for disease assessment.
Observation:
- Two patients with undiagnosed long-standing fever were referred for whole-body 18F-FDG PET-CT scans.
- The 18F-FDG PET-CT scans were performed to investigate the cause of their persistent fevers (pyrexia of unknown origin).
Findings:
- Blood cultures confirmed the presence of *Burkholderia pseudomallei* in both patients, establishing the diagnosis of Melioidosis.
- The 18F-FDG PET-CT imaging played a crucial role in evaluating the extent of the disease in these patients.
Implications:
- 18F-FDG PET-CT is a valuable tool for diagnosing and staging Melioidosis, particularly in complex cases.
- Early and accurate diagnosis facilitated by advanced imaging can guide appropriate treatment strategies for this debilitating infection.
- This case series highlights the utility of 18F-FDG PET-CT in identifying rare infectious diseases like Melioidosis, contributing to better patient outcomes.
