Incidental unilateral tuberculous sacroiliitis detected by 18F-FDG PET/CT in a patient with abdominal tuberculosis.

Document Type: Case report

Authors

1 Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy

2 Department of Nuclear Medicine and PET/CT Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland

3 Division of Internal Medicine, Montichiari Hospital, Brescia, Italy

Abstract

Tuberculosis is a systemic disease which involves skeletal and articular system very rarely. Osteoarticular tuberculosis commonly occurs in the vertebral column and more rarely in the sacroiliac joints. In this study, we report a 44-years-old male patient with low-grade fever, malabsorption syndrome, abdominal and pelvic ascites and low-back pain, that underwent 18F-FDG PET/CT for identifying the cause of signs and symptoms after a negative abdominal CT and negative thorax radiography. The study revealed increased tracer uptake at the peritoneal ascites and at the right sacroiliac joint in absence of bone alteration suggesting a sacroiliitis. Staining of the ascitic fluid was positive for acid-fast bacilli (Ziehl–Neelsen) and in the subsequent abdominal paracentesis Mycobacterium Tuberculosis was isolated; the final diagnosis was abdominal tuberculosis with a sacroiliac joint involvement. The patient started antitubercular therapy for 6 months and the clinical conditions were resolved, in particular both back pain and ascites disappeared.

Keywords

Main Subjects


1. Papagelopoulos PJ, Papadopoulos EC, Mavrogenis AF, Themistocleous GS, Korres DS, et al. Tuberculousis sacroiliitis. A case report and review of the literature. Eur Spine J. 2005;14(7):683-8.

2. Kim NH, Lee HM, Yoo JD, Suh JS. Sacroiliac joint tuberculosis. Classification and treatment. Clin Orthop Relat Res. 1999;358:215–22.

3. Gelal F, Sabah D, Doğan R, Avcı A. Multifocal skeletal tuberculosis involving the lumbar spine and a sacroiliac joint: MR imaging findings. Diagn Interv Radiol. 2006;12(3):139-41.

4. Salomon CG, Ali A, Fordham EW. Bone scintigraphy in tuberculous sacroiliitis. Clin Nucl Med. 1986;11(6):407-8.

5. Harkirat S, Anana SS, Indrajit LK, Dash AK. Pictorial essay: PET/CT in tuberculosis. Indian J Radiol Imaging. 2008;18(2):141-7.

6. Moore SL, Rafii M. Imaging of musculoskeletal and spinal tuberculosis. Radiol Clin North Am. 2001;39(2):329–42.

7. Paustian FF. Tuberculosis of the intestine. In: Bockus HL, editor. Gastroenterology. 2nd ed. Philadelphia: WB Saunders; 1964. P. 311.

8. van Gaalen FA, Bakker PA, de Hooge M, Schoones JW, van der Heijde D. Assessment of sacroiliitis by radiographs and MRI: where are we now? Curr Opin Rheumatol. 2014;26(4):384-8.

9. Grigoryan M, Roemer FW, Mohr A, Genant HK. Imaging in spondyloarthropathies. Curr Rheumatol

Rep. 2004;6(2):102-9.

10. Glaudemans AW, de Vries EF, Galli F, Dierckx RA, Slart RH, Signore A. The use of 18F-FDG-PET/CT for diagnosis and treatment monitoring of inflammatory and infectious diseases. Clin Dev Immunol. 2013;2013:623-36.

11. Ho CL, Wu WC, Chen S, Leung YL, Cheng TK. F-18 FDG PET/CT in an adult case of group B streptococcal sacroiliitis. Clin Nucl Med. 2010;35(10):834-5.

12. Bertagna F, Giubbini R, Biasiotto G, Rosenbaum J, Alavi A. Incidental inflammatory findings in nerves and in patients with neoplastic diseases evaluated by 18F-FDG-PET/CT. Hell J Nucl Med. 2009;12(3):279-80.

13. Yamashita H, Kubota K, Takahashi Y, Minamimoto R, Morooka M, Kaneko H, et al. Similarities and differences in fluorodeoxyglucose positron emission tomography/computed tomography findings in spondyloarthropathy, polymyalgia rheumatic and rheumatoid arthritis. Joint Bone Spine. 2013;80(2):171-7.

14. Strobel K, Fischer DR, Tamborrini G, Kyburz D, Stumpe KD, Hesselmann RG, et al. 18F-fluoride PET/CT for detection of sacroiliitis in ankylosing spondylitis. Eur J Nucl Med Mol Imaging. 2010;37(9):1760-5.

15. Ovadia D, Metser U, Lievshitz G, Yaniv M, Wientroub S, Even-Sapir E. Back pain in adolescents: assessment with integrated 18F-fluoride positron-emission tomography-computed tomography. J Pediatr Orthop. 2007;27(1):90-3.

16. Ozmen O, Gokcek A, Tatci E, Biner I, Akkalyouncu B. Integration of PET/CT in current diagnostic and response evaluation methods in patients with tuberculosis. Nucl Med Mol Imaging. 2014;48(1):75-8.

17. Ernst D, Baerlecken N, Schmidt R, Witte T. Large vessel vasculitis and spondyloarthritis: coincidence or associated diseases? Scand J Rheumatol. 2014;43(3):246-8.