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INTERESTING IMAGE
Year : 2022  |  Volume : 37  |  Issue : 2  |  Page : 202-203  

F-18 fluorodeoxyglucose positron-emission tomography/computed tomography image of rare case of phaeohyphomycosis causing osteomyelitis of scapula in a postrenal transplant recipient


1 Department of Nuclear Medicine, Kovai Medical Center and Hospital Limited, Coimbatore, Tamil Nadu, India
2 Department of Nephrology, Kovai Medical Center and Hospital Limited, Coimbatore, Tamil Nadu, India
3 Department of Pathology, Kovai Medical Center and Hospital Limited, Coimbatore, Tamil Nadu, India
4 Department of Plastic Surgery, Kovai Medical Center and Hospital Limited, Coimbatore, Tamil Nadu, India

Date of Submission19-Oct-2021
Date of Decision27-Dec-2021
Date of Acceptance29-Dec-2021
Date of Web Publication08-Jul-2022

Correspondence Address:
Dr. Koramadai Karuppusamy Kamaleshwaran
Department of Nuclear Medicine, PET/CT and Radionuclide Therapy, Kovai Medical Center and Hospital Limited, Coimbatore - 641 014, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.ijnm_163_21

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   Abstract 


Phaeohyphomycosis belongs to a heterogeneous group of fungal infections, originally described by Ajello et al. as mycoses, whose etiologic agents develop in host tissue as dark-walled, septate mycelial elements. Disseminated infections occur in immunocompromised patients, involving the paranasal sinuses, eyes, central nervous system, lymph nodes, and bone. We present here an interesting image of 18F fluorodeoxyglucose positron-emission tomography/computed tomography showing scapula osteomyelitis caused by phaeohyphomycosis.

Keywords: Bone, fluorodeoxyglucose positron-emission tomography/computed tomography, immunocompromised, phaeohyphomycosis


How to cite this article:
Kamaleshwaran KK, Ramkumar E, Pathak V, Mehta SS, Kale SM. F-18 fluorodeoxyglucose positron-emission tomography/computed tomography image of rare case of phaeohyphomycosis causing osteomyelitis of scapula in a postrenal transplant recipient. Indian J Nucl Med 2022;37:202-3

How to cite this URL:
Kamaleshwaran KK, Ramkumar E, Pathak V, Mehta SS, Kale SM. F-18 fluorodeoxyglucose positron-emission tomography/computed tomography image of rare case of phaeohyphomycosis causing osteomyelitis of scapula in a postrenal transplant recipient. Indian J Nucl Med [serial online] 2022 [cited 2022 Aug 10];37:202-3. Available from: https://www.ijnm.in/text.asp?2022/37/2/202/350263



A 36-year-old woman with postrenal transplant done 6 years before was on immunosuppression, on follow-up, presented with pain and difficulty in lifting left arm for 1 month. Magnetic resonance imaging of the left shoulder joint [Figure 1] showed a soft-tissue lesion in the spine of the scapula suggestive of primary bone neoplasm. She was referred for 18F fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) which showed intensely hypermetabolic lytic areas with soft-tissue necrotic lesion involving spine of left scapula, with a maximum standardized uptake value of 19.8 [Figure 2]. Biopsy of the lesion showed many branching septate and pigmented hyphae in dense infiltrate of histiocytes suggestive of phaeohyphomycosis [Figure 3]. She underwent wide local excision and scapulectomy. Final pathology also confirmed phaeohyphomycosis. She was started on antifungal medications and was asymptomatic on follow-up.
Figure 1: Magnetic resonance imaging of the left shoulder showing soft-tissue lesion involving spine of scapula

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Figure 2: Maximum intensity projection (a), axial computed tomography (b), axial positron-emission tomography (c), coronal fused F-18 positron-emission tomography/computed tomography (d) showing intensely hypermetabolic lytic lesion with soft-tissue lesion in the left scapula (red arrow), standardized uptake value of 19.8. Also, transplant kidney noted in right iliac fossa

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Figure 3: Photomicrograph of histopathological section shows pigmented branching short septate hyphae and spores in aggregates and within giant cells (H and E, ×40)

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Phaeohyphomycosis is a group of fungal infections characterized by the presence of septate pigmented hyphae in the tissues and includes cutaneous, subcutaneous, and systemic infections. Phaeohyphomycosis is the term used for infections caused by dematiaceous fungi with the characteristic presence of melanin pigment in their cell walls. Branching septate and fungal hyphae were observed within and in between giant cells in hematoxylin and eosin-stained sections.[1] Invasive fungal infections are common in immunocompromised patients. Bone involvement of phaeohyphomycosis is very rare.[2] The major role of FDG PET/CT in fungal infection is to reveal the extent of disease, and it can also serve as a valuable tool in monitoring the treatment response to antifungal therapy. Fungal infection could be a cause of false-positive results on FDG PET/CT performed for malignancy.[3] Our case is the first case of 18F-FDG PET/CT image of rare case of bone phaeohyphomycosis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Kumar KK, Hallikeri K. Phaeohyphomycosis. Indian J Pathol Microbiol 2008;51:556-8.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Mesa A, Henao J, Gil M, Durango G. Phaeohyphomycosis in kidney transplant patients. Clin Transplant 1999;13:273-6.  Back to cited text no. 2
    
3.
Sharma P, Mukherjee A, Karunanithi S, Bal C, Kumar R. Potential role of 18F-FDG PET/CT in patients with fungal infections. AJR Am J Roentgenol 2014;203:180-9.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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