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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE
A Journal on Internal Medicine and Pharmacology
Indexed/Abstracted in: BIOSIS Previews, EMBASE, Scopus, Emerging Sources Citation Index
Gazzetta Medica Italiana Archivio per le Scienze Mediche 2012 June;171(3):351-6
Different causes of 18-Fluorine-labelled-2-deoxy-2-fluoro-D-glucose uptake in a patient with non-Hodgkin lymphoma
Niccoli Asabella A., Notaristefano A., Pisani A. R., Iuele F., Altini C., Rubini G.
Nuclear Medicine Unit, Di.M.I.M.P., University of Bari, Bari, Italy
We report the case of a 64-year-old woman affected by Non Hodgkin Lymphoma (NHL), who showed immunosuppression after chemotherapy, joint pain at the left hip joint, that will result a septic arthritis. To restage the NHL after chemotherapy 18F-FDG-PET/CT was performed, the whole-body acquisition showed increased glucose uptake in the carenal and right paratracheal lymphnodes. Other sites of increased glucose uptake have been seen in the bone tissue and soft tissues around the left femoral head and neck, in the homolateral acetabulum and also in the muscular insertions of the right hip. The 18F-FDG-PET/CT findings, the clinical history and the symptoms raised the suspect of a septic process of left hip joint. 99mTc-sulesomab (LeukoScan®, Immunomedics®, New Plains, NJ, USA) scan performed in antalgic position (flexed lower leg) showed pathological radiopharmaceutical uptake in the soft tissues around the left acetabulum cavity and homolateral femoral head and neck. Two blood cultures from samples obtained at admission were both positive for Escherichia coli, resistant to cefazolin and gentamicin and responsive to ciprofloxacin and cotrimoxazole. The patient was treated with intravenous ciprofloxacin and rest for 15 days. The fever and the left hip pain gradually resolved. After the end of antibiotic therapy, the patient restarted the NHL chemotherapy cycle and is now in follow-up. A careful anamnesis, examination and review of previous diagnostic tests, permit to assign the right meaning to every site of 18F-FDG uptake and use them for the best clinical management of the patients.