Infected plastic biliary stent identified by FDG PET/CT: A case report

The diagnostic evaluation of patients presenting with fever can be challenging, especially in cases where conventional imaging modalities fail to reveal a definitive focus of infection. This case illustrates the diagnostic value of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in detecting infected biliary stents as a persistent nidus of sepsis.

An 82-year-old woman presented with recurrent episodes of fever, chills, and myalgia. Despite multiple hospitalizations and temporary improvement with empirical antibiotics, her symptoms recurred after discharge.

FDG PET/CT revealed focal FDG uptake at the proximal tip and linear hypermetabolism along the distal portions of the biliary stents, suggestive of infection. Endoscopic examination confirmed major duodenal papillitis, diffuse biofilm formation, and biliary sludges at the stent tips. Microbiological cultures identified Escherichia coli and Klebsiella pneumoniae.

Endoscopic removal of the biliary stents was performed, followed by targeted antimicrobial therapy based on culture results.

The patient experienced resolution of febrile episodes and improvement in laboratory inflammatory markers following stent removal and appropriate antibiotic treatment.

FDG PET/CT could serve as a valuable diagnostic modality in patients with recurrent fever and a history of biliary intervention, by enabling the identification of infected indwelling stents. Early use of FDG PET/CT could help avoid unnecessary procedures and guide timely interventions.