Intense Accumulation of F-18 FDG in Colonic Wall in Adult Onset Still Disease With Pseudomembranous Colitis

摘要

Pseudomembranous colitis (PMC) is a severe form of Clostridium difficile associated diarrhea (CDAD), and it occurs more frequently in immunosuppressed patients. Accurate and early diagnosis is important in the successful management of CDAD. Adult onset Still disease (AOSD) has an unknown etiology and is characterized by fever, rash, and arthritis. There is no single diagnostic test for AOSD; therefore, diagnosis is based on clinical criteria and exclusion of infectious, neoplastic, and autoimmune diseases. Diagnosis of PMC requires a high index of clinical suspicion in a hospitalized patient with diarrhea, fever, and leukocytosis, but diarrhea could not be included because of associated paralytic ileus. We describe a case of diffuse FDG uptake in the rectosigmoid colonic wall in AOSD patient with PMC. In this case, the PET/CT finding was a first clue for diagnosis of CDAD in this case because fever and leukocytosis were already present due to underlying AOSD.