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| INTERESTING IMAGE |
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| Year : 2022 | Volume
: 37
| Issue : 2 | Page : 194-195 |
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Fluorodeoxyglucose Positron Emission Tomography Imaging in Pneumocystis jiroveci Pneumonia
Hemant Rathore1, Nirav Thaker2, Inder Talwar2
1 Department of Nuclear Medicine and PET CT, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
2 Department of Radiodiagnosis, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| Date of Submission | 15-Sep-2021 |
| Date of Acceptance | 04-Oct-2021 |
| Date of Web Publication | 08-Jul-2022 |
Correspondence Address:
Dr. Hemant Rathore
Department of Nuclear Medicine and PET CT, Bombay Hospital and Medical Research Centre, 12 Marine Lines, Mumbai - 400 020, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijnm.ijnm_140_21
 Abstract | | |
Fever or pyrexia of unknown origin (PUO) is commonly defined as body temperature higher than 38.3°C on several occasions for a period of at least 3 weeks with uncertain diagnosis after initial routine obligatory investigations. In most cases of PUO, there is an uncommon presentation of a common disease which includes infection, noninfectious inflammatory diseases, malignancy, and miscellaneous causes. We present an interesting case of a 48-year-old man with PUO, who is a known case of multiple myeloma on immunosuppressive therapy, where 18F-fluorodeoxyglucose positron emission tomography-computed tomography was able to detect occult cause of infective etiology.
Keywords: 18F-fluorodeoxyglucose, Pneumocystis carinii, Pneumocystis jiroveci pneumonia, positron emission tomography-computed tomography, pyrexia of unknown origin
How to cite this article:
Rathore H, Thaker N, Talwar I. Fluorodeoxyglucose Positron Emission Tomography Imaging in Pneumocystis jiroveci Pneumonia. Indian J Nucl Med 2022;37:194-5 |
How to cite this URL:
Rathore H, Thaker N, Talwar I. Fluorodeoxyglucose Positron Emission Tomography Imaging in Pneumocystis jiroveci Pneumonia. Indian J Nucl Med [serial online] 2022 [cited 2022 Aug 10];37:194-5. Available from: https://www.ijnm.in/text.asp?2022/37/2/194/350252 |
| Background and Procedure | |  |
We describe a case of a 48-year-old man with pyrexia of unknown origin (PUO), who is a known case of multiple myeloma on immunosuppressive therapy, with remission of disease on recent bone marrow examination. This case presented with dry cough and fever over 4 weeks (100°F–102°F) and had an oxygen saturation of 97% on ambient air. The blood tests apart from mild leukopenia were fairly unremarkable. The chest radiography revealed subtle bilateral lung ground-glass opacities and referred for fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomographic (CT) scan to rule out the cause. The FDG-PET scan [Figure 1] revealed diffuse increased metabolic activity in bilateral lungs; the corresponding fused high-resolution CT (HRCT) images showed the acute lung changes in the form of hypermetabolic ill-defined confluent ground-glass opacities with interstitial thickening and crazy paving appearance near completely involving bilateral lungs along with mild bronchial and bronchiolar dilatation [Figure 2]. The imaging was suggestive of acute atypical pneumonia which was further investigated by bronchoalveolar lavage cytological examination and culture which demonstrated Pneumocystis jiroveci. | Figure 1: Whole-body fluorodeoxyglucose positron emission tomography scan maximum intensity projection image reveals diffuse increased metabolic activity in bilateral lungs with physiological fluorodeoxyglucose uptake in rest of the visualized body
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 | Figure 2: High-resolution computed tomography (left), and fused fluorodeoxyglucose positron emission tomography and high-resolution computed tomography (right) images reveals hypermetabolic ill-defined confluent ground-glass opacities with interstitial thickening near completely involving bilateral lungs
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Pneumocystic jiroveci pneumonia (PJP), is also known as pneumocystic pneumonia or formerly pneumocystic carinii pneumonia, is caused by the ubiquitous unicellular eukaryote, P jiroveci, which is a rare cause of infection in the general population, but it is a more frequent cause of morbidity and mortality in immunocompromised persons who are especially with HIV AIDS, postorgan-transplant recipients, and those receiving long-term cytotoxic or steroid therapy, hematological malignancies, as well as other malignancies.[1] PJP is classified as a fungal pneumonia but does not respond to antifungal therapy. These patients have a long clinical course over months to years, with stable symptoms and radiographic abnormalities corresponding to pathologic findings of traction bronchiectasis, honeycombing, and interstitial fibrosis.
In a study of 105 pneumocystic pneumonia immunocompromised patients, chest radiographic findings were divided into three stages: early stage; normal or nearly normal chest radiograph, mid-stage; bilateral pulmonary infiltrates, and late stage; bilateral pulmonary consolidation. Chest HRCT findings were also divided into three stages: early stage; bilateral diffuse ground-glass opacity, mid-stage; bilateral diffuse ground-glass opacity with patchy consolidations, and late stage; bilateral diffuse consolidation).[2]
| Conclusion | | |
FDG-PET/CT imaging is a very sensitive diagnostic modality for the evaluation of fever of unknown origin by facilitating anatomical localization of focally increased FDG uptake and thereby guiding further diagnostic tests to achieve a final diagnosis.[3] Few studies suggest that FDG-PET scan have an important role to play in the diagnosis and monitoring treatment response of pneumocystic pneumonia in the immunocompromised patients.[4]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Bollée G, Sarfati C, Thiery G, Bergeron A, de Miranda S, Menotti J, et al. Clinical picture of Pneumocystis jiroveci pneumonia in cancer patients. Chest 2007;132:1305-10.  |
| 2. | Mu XD, Jia P, Gao L, Su L, Zhang C, Wang RG, et al. Relationship between radiological stages and prognoses of pneumocystis pneumonia in non-AIDS immunocompromised patients. Chin Med J (Engl) 2016;129:2020-5. |
| 3. | Kouijzer IJ, Mulders-Manders CM, Bleeker-Rovers CP, Oyen WJ. Fever of unknown origin: The value of FDG-PET/CT. Semin Nucl Med 2018;48:100-7. |
| 4. | Win Z, Todd J, Al-Nahhas A. FDG-PET imaging in Pneumocystis carinii pneumonia. Clin Nucl Med 2005;30:690-1. |
[Figure 1], [Figure 2]
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