Abnormal renal uptake in indium-111-chloride scanning

Area of Science:

• Nuclear medicine
• Hepatology
• Infectious disease

Background:

• Alcoholic liver disease (ALD) can severely impair liver function.
• The reticuloendothelial system (RES) plays a crucial role in liver immunity and clearance.
• Assessing RES function is vital for understanding disease severity and progression.

Observation:

• A patient with severe alcoholic liver disease presented with near-complete suppression of hepatic RES function.
• Technetium-99m sulfur colloid (99mTc-SC) scintigraphy indicated severely depressed RES function.
• Iodine-131 rose bengal imaging suggested concurrent obstructive biliary disease.

Findings:

• Indium-111 chloride (111In-Cl) scintigraphy confirmed the depressed RES function.
• Abnormal 111In-Cl uptake was observed in the kidneys.
• This renal uptake was potentially linked to urinary tract infection with gamma enterococci and subsequent inflammatory infiltration.

Implications:

• This case highlights the profound impact of severe alcoholic liver disease on RES function.
• Nuclear imaging techniques (99mTc-SC, 131I-rose bengal, 111In-Cl) are valuable for evaluating liver and biliary disease.
• The findings suggest a potential link between severe liver disease, compromised RES function, and secondary infections like UTIs.