Localization of Pyelonephritis by ⁶⁸Ga-FAPI PET CT

Fibroblast activation protein inhibitor (FAPI) is a quinoline-based membrane-bound glycoprotein enzyme that is not usually expressed in normal adult tissues, except for the myometrium and sometimes the pancreas. Its expression increases in inflammation and cancer-associated fibroblasts (CAF). As FAPI is a new molecule with a promising future, presented here is a case report of uncontrolled diabetes with abdominal pain that showed features of inflammation in the kidneys. The patient had been previously diagnosed with maxillary sinusitis with Aspergillus niger and was receiving antibiotic treatment. The urine culture performed later was negative, and the patient was referred for ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) PET Computed Tomography (CT) to look for the focus of infection. However, as blood sugar was 500 mg/dL, ¹⁸F-FDG PET CT could not be performed. Therefore, ⁶⁸Ga-FAPI PET CT was run instead after taking the patient's written informed consent. The ^99mTc-dimercaptosuccinic acid scan performed on another day confirmed the presence of pyelonephritis bilaterally. In situations where FDG cannot be used because of hyperglycemia, ⁶⁸Ga-FAPI PET CT scan may be considered an alternative in the detection of occult infection or inflammation, as demonstrated in this case report.