Unexpected cloud-like lesion on gallium-67 scintigraphy: detection of subcutaneous abscess underneath the skin with normal appearance in a comatose patient in an intensive care setting.

摘要

A 58-year-old comatose patient, with a history of diabetes mellitus, chronic kidney disease, and hypertension, presented with 4 weeks of persisting fever in an intensive care setting. Physical examination did not reveal any localizing focus of infection; no warmth, erythema, edema, or tenderness was noted. Therefore, a whole -body Gallium-67 scintigraphy was performed to detect occult infection. Planar images (Figure 1) at 48 hours after intravenous injection of 5 mCi Gallium-67 citrate demonstrated a cloud-like lesion with relative central photopenia and increased peripheral uptake in the region of upper back (arrow). Confirmatory computed tomography imaging of the chest (Figure 2) showed an extensive abscess in the same location (arrows). Pus culture of the lesion grew Acinetobacter baumannii. Acinetobacter infections have long been clinically prominent in tropical countries and have recently caused multihospital outbreaks in temperate climates. Most alarming is the ability of the organism to accumulate diverse mechanisms of resistance, with the emergence of strains that are resistant to all commercially available antibiotics. Because of accurate and early detection of the infectious focus, the patient was promptly treated with appropriate antibiotics, to which he responded well.