Asia Oceania Journal of Nuclear Medicine and Biology

Asia Oceania Journal of Nuclear Medicine and Biology

Bone Scan in Identification, Assessment of Initial Extent and Response to Therapy in Polymyositis

Document Type : Case report

Authors
Malik Eid Juweid 1
Noor Mashhadani 1
Omar Albtoush 1
Rahma Doudeen 1
Ahmad Al-Momani 2
Mohammed Aloqaily 2
Akram Al-ibraheem 3
1 Department of Radiology and Nuclear Medicine, School of Medicine, University of Jordan, Amman, Jordan
2 School of Medicine, The University of Jordan, Amman, Jordan
3 Department of Nuclear Medicine, King Hussein Cancer Center, Amman, Jordan
10.22038/aojnmb.2021.57818.1403
Abstract
This is a 51-year-old male who presented with abdominal pain, bilateral proximal upper and lower extremities pain and weakness, and decreased urine output with abnormal kidney function test; Urea and creatinine levels were elevated at 231.5 mg/dl and 11.05 mg/dl, respectively. Initial bone scan showed increased uptake within several muscles suspicious for polymyositis, this was confirmed by biopsy of the right triceps, identified by bone scan as the best superficial biopsy site. Pelvis and thigh MRI demonstrated diffuse hyperintense signal on fluid sensitive sequences involving several muscles. Renal biopsy showed acute tubular injury. He was treated with steroids resulting in significant improvement. A repeat bone scan showed near complete resolution of the muscular uptake seen at presentation. This case nicely illustrates the role of bone scanning in the initial recognition and determination of the extent of polymyositis with identification of a suitable biopsy site as well as assessment of response to treatment.
Keywords
Polymyositis
Bone scan
MRI
  1. Jakubowski JK, Patel R, Buddharaju V. Polymyositis Presenting as Rhabdo-myolysis after the Initiation of Omeprazole. Cureus. 2020; 12(5):e8125.
  2. Scott JA, Palmer EL, Fischman AJ. HIV-Associated Myositis Detected by Radio-nuclide Bone Scanning. J Nucl Med. 1989; 30(4):556-8.
  3. Tomasová Studýnková J, Charvát F, Jarošová K, Vencovský J. The role of MRI in the assessment of polymyositis and dermato- Rheumatology. 2007; 46(7):1174-9.
  4. Biyi A, Doudouh A. Muscular visualisation on a bone scan in paraneoplastic dermato-myositis associated with breast cancer Pan Afr Med J. 2016; 22:23:9.
  5. An YS, Suh CH, Jung JY, Kim HA. Role of bone scan in the assessment of polymyositis/ dermatomyositis Clin Rheumatol. 2015; 34 (4):699-706.
  6. Spies SM, Swift TR, Brown M. Increased 99mTc-polyphosphate muscle uptake in a patient with polymyositis: case report. J Nucl Med. 1975; 16(12):1125–7.
  7. Steinfeld JR, Thorne NA, Kennedy TF. Positive 99mTc-pyrophosphate bone scan in polymyositis. Radiology. 1977; 122(1): 168.
  8. Ramírez G, Asherson RA, Khamashta MA,Cervera R, D’Cruz D, Hughes GRV. Adult-onset polymyositis-dermatomyositis: Description of 25 patients with emphasis on treatment. Semin Arthritis Rheum. 1990; 20(2):114-20.
  9. Strauss’ KW, Gonzalez-Buritica H, Khamashta MA, Hughes GR V. Polymyositis- dermato-myositis: a clinical Postgrad Med J. 1989; 65:437–43.
  10. Lafforgue P, Siles S, Daumen-Legré V, Acquaviva PC. An unexpected, benign cause of increased muscular uptake at bone scintigraphy. Clin Exp Rheumatol. 1994; 12 (3):309–11.
  11. Joshi D, Kumar N, Rai A. Dermatomyositis presenting with rhabdomyolysis and acute renal failure; an uncommon manifestation. Ann Indian Acad Neurol. 2009; 12(1):45–7.
Asia Oceania Journal of Nuclear Medicine and Biology
Volume 10, Issue 1
January 2022
Pages 64-67