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F-18 Fluorodeoxyglucose Positron-Emission Tomography/Computed Tomography Image of Rare Case of Phaeohyphomycosis Causing Osteomyelitis of Scapula in a Postrenal Transplant Recipient
Address for correspondence: 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. E-mail: dr.kamaleshwar@gmail.com
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This article was originally published by Wolters Kluwer - Medknow and was migrated to Scientific Scholar after the change of Publisher.
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
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.
- Magnetic resonance imaging of the left shoulder showing soft-tissue lesion involving spine of scapula
- 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
- Photomicrograph of histopathological section shows pigmented branching short septate hyphae and spores in aggregates and within giant cells (H and E, ×40)
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
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