Annals of Nuclear Medicine

, Volume 28, Issue 2, pp 167–171 | Cite as

Disseminated osteomyelitis or bone metastases of breast cancer: 18F-FDG-PET/CT helps unravel an unusual presentation

  • Ramin Mandegaran
  • Alexa Debard
  • Muriel Alvarez
  • Bruno Marchou
  • Patrice Massip
  • Thomas Wagner
Case Report
First Online:
Received:
Accepted:

Abstract

We present a case wherein striking 18F-FDG-PET/CT findings initially considered consistent with recurrent disseminated skeletal metastases of breast cancer were later identified as an unusual presentation of disseminated chronic pyogenic osteomyelitis with Staphylococcus aureus and warneri identified on microbiological culture. A 76-year-old female with previous history of breast cancer presented with a 6-month history of pyrexia, myalgia and weight loss. Besides neutrophilia and elevated C-reactive protein, other blood indices, cultures and conventional imaging failed to identify the cause of pyrexia of unknown origin (PUO). 18F-FDG-PET/CT demonstrated multiple widespread foci of intense FDG uptake in lytic lesions throughout the skeleton. Coupled with previous history of malignancy, findings were strongly suggestive of disseminated metastases of breast cancer. Through targeting an FDG avid lesion, 18F-FDG-PET/CT aided CT-guided biopsy, which instead identified the lesions as chronic pyogenic osteomyelitis. Following prolonged antibiotic therapy, repeat 18F-FDG-PET/CT demonstrated significant resolution of lesions. This case demonstrated an unusual presentation of disseminated osteomyelitis on 18F-FDG-PET/CT and highlighted the use of 18F-FDG-PET/CT as a trouble shooter in PUO but demonstrated that unusual presentations of benign or malignant pathologies cannot always reliably be differentiated on imaging alone without aid of tissue sampling. Furthermore, this case highlights the potential role 18F-FDG-PET/CT could provide in assessing response to antibiotic therapy.

Keywords

18F-FDG-PET/CT Osteomyelitis Bone metastases PUO Antibiotic response 
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Notes

Acknowledgments

No funding was received for this work.

Conflict of interest

As the first author, I (Ramin Mandegaran) confirm that none of the authors involved in the above titled case report have any potential conflicts of interest to declare.

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Copyright information

© The Japanese Society of Nuclear Medicine 2013

Authors and Affiliations

  • Ramin Mandegaran
    • 1
  • Alexa Debard
    • 2
  • Muriel Alvarez
    • 2
  • Bruno Marchou
    • 2
  • Patrice Massip
    • 2
  • Thomas Wagner
    • 1
  1. 1.Department of Nuclear MedicineThe Royal Free London NHS TrustLondonUK
  2. 2.Department of Infectious DiseaseToulouse University Hospital, Hôpital Purpan ToulouseToulouseFrance

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