A case of skeletal tuberculosis and psoas abscess: disease activity evaluated using 18 F-fluorodeoxyglucose positron emission tomography-computed tomography

BMC Medical Imaging

Naoki Hasegawa⁴  Tomoko Betsuyaku²  Kenzo Soejima²  Kota Watanabe³  Ken Ishii³  Kazuma Yagi²  Kota Ishioka²  Koji Murakami¹  Makoto Ishii²  Yoshifumi Kimizuka² 

[1] Division of Nuclear Medicine, Department of Diagnostic Radiology, School of Medicine, Keio University, Tokyo, Japan;Division of Pulmonary Medicine, School of Medicine, Keio University, 35 Shinanomachi Shinjuku-ku, Tokyo 160-8582, Japan;Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan;Center for Infectious Diseases and Infection Control, School of Medicine, Keio University, Tokyo, Japan

关键词: Extrapulmonary tuberculosis;    Skeletal tuberculosis;    Gravitation abscess;    Psoas abscess;    PET-CT;   

Others  :  1090427
DOI  :  10.1186/1471-2342-13-37

 received in 2013-04-23, accepted in 2013-11-08,  发布年份 2013

【 摘 要 】

Background

Psoas abscess complicating tuberculous spondylitis is a rare morbidity in extrapulmonary tuberculosis. There are no established guidelines for evaluating the clinical response of psoas abscess. Although several studies have shown that positron emission tomography-computed tomography with ¹⁸ F-fluorodeoxyglucose can play a potential role in diagnosing multifocal tuberculosis and monitoring the clinical response of pulmonary tuberculosis, to our knowledge, this is the first report demonstrating that positron emission tomography-computed tomography is useful for evaluating local inflammation and disease activity of a tuberculous psoas abscess.

Case presentation

We report a case of multifocal bone and lymph node tuberculosis with concomitant lumbar psoas abscess in a 77-year-old man, along with a literature review. An initial positron emission tomography-computed tomography scan showed intense ¹⁸ F-fluorodeoxyglucose accumulation in the sternum, ribs, vertebrae, and lymph nodes. The patient was successfully treated with antitubercular agents and computed tomography-guided drainage therapy. A follow-up positron emission tomography-computed tomography after abscess drainage and 9 months of antitubercular drug treatment revealed that the majority of lesions improved; however, protracted inflammation surrounding the psoas abscess was still observed. These results indicate that disease activity of psoas abscess can remain, even after successful drainage and antitubercular medication regime of appropriate duration.

Conclusion

We have successfully followed up the extent of skeletal tuberculosis complicated with psoas abscess by positron emission tomography-computed tomography. In this patient, positron emission tomography-computed tomography is useful for evaluating the disease activity of tuberculous psoas abscess and for assessing the appropriate duration of antitubercular drug therapy in psoas abscess.

【 授权许可】

   
2013 Kimizuka et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Peto HM, Pratt RH, Harrington TA, LoBue PA, Armstrong LR: Epidemiology of extrapulmonary tuberculosis in the United States, 1993–2006. Clin Infect Dis 2009, 49:1350-1357.
• [2]Teo HE, Peh WC: Skeletal tuberculosis in children. Pediatr Radiol 2004, 34:853-860.
• [3]Harrigan RA, Kauffman FH, Love MB: Tuberculous psoas abscess. J Emerg Med 1995, 13:493-498.
• [4]Boxer DI, Pratt C, Hine AL, McNicol M: Radiological features during and following treatment of spinal tuberculosis. Br J Radiol 1992, 65:476-479.
• [5]Treglia G, Taralli S, Calcagni ML, Maggi F, Giordano A, Bonomo L: Is there a role for fluorine 18 fluorodeoxyglucose-positron emission tomography and positron emission tomography/computed tomography in evaluating patients with mycobacteriosis? A systematic review. J Comput Assist Tomogr 2011, 35:387-393.
• [6]Tian G, Xiao Y, Chen B, Xia J, Guan H, Deng Q: FDG PET/CT for therapeutic response monitoring in multi-site non-respiratory tuberculosis. Acta Radiol 2010, 51:1002-1006.
• [7]Hopewell PC: Overview of clinical tuberculosis. In Tuberculosis: pathogenesis, protection, and control. Edited by Bloom BR. Washington DC: American Society for Microbiology Press; 1994:25-46.
• [8]Dutt AK, Moers D, Stead WW: Short-course chemotherapy for extrapulmonary tuberculosis. Nine years' experience. Ann Intern Med 1986, 104:7-12.
• [9]Blumberg HM, Burman WJ, Chaisson RE, Daley CL, Etkind SC, Friedman LN, Fujiwara P, Grzemska M, Hopewell PC, Iseman MD, Jasmer RM, Koppaka VR, Menzies RI, O'Brien RJ, Reves RR, Reichman LB, Simone PM, Starke JR, Vernon AA: American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med 2003, 167:603-662.
• [10]Blumberg HM, Leonard MK Jr, Jasmer RM: Update on the treatment of tuberculosis and latent tuberculosis infection. JAMA 2005, 293:2776-2784.
• [11]American Academy of Pediatrics Committee on Infectious Diseases: Chemotherapy for tuberculosis in infants and children. Pediatrics 1992, 89:161-165.
• [12]McDonald M, Sexton D: Skeletal tuberculosis. [http://www.uptodate.com/contents/skeletal-tuberculosis webcite]