Comparative Ga-67 citrate and bone scintigraphy in disseminated blastomycosis.

Abstract

Blastomycosis is a systemic illness, and the disease eventually spreads to multiple organs or develops multifocal involvement. Cutaneous and skeletal involvement are the two most common extrapulmonary manifestations. Because serologic and skin tests are not reliable, diagnosis of the disease is made only by visualization of the organism in tissue, sputum, exudates, or by culture. Ga-67 citrate and whole-body bone imaging may play important roles in diagnosis. The authors describe a patient with disseminated blastomycosis proved by skin biopsy who underwent bone and Ga-67 citrate whole-body imaging. Both bone and Ga-67 citrate studies showed a large area of increased uptake in the entire upper third of the proximal right tibia, and focal lesions in the left femur and in the skin of the chin. Ga-67 citrate imaging did not reveal the T-10 vertebra and two rib lesions, a pulmonary lesion, or other skin lesions. The patient received amphotericin B and traconazole therapy. The right tibia lesion resolved, as evidenced by a radiologic examination performed 5 months later.