PET scan in a patient with pneumococcal sepsis

Abstract

A 63-year-old man presented to the Otolaryngology department with severe dysphagia. On laryngoscopy, a whitish nodule 3 cm in size exiting from the posterior commissurae of the larynx, and almost obstructing the hypopharyngeal space, was observed. The excision biopsy specimen was diagnosed as moderately differentiated squamous cell carcinoma of the hypopharynx. A staging procedure with positron emission tomography-computer tomography (PET-CT) was recommended. The day before the procedure, the patient experienced chills, and his temperature increased up to 38.9 C. He was evaluated in the emergency department (ED) of our hospital. The plain film of the chest X-ray study revealed a small infiltrate in the right lower lobe (arrows Fig. 1a, b) and the patient was discharged on oral antimicrobial therapy to manage his pneumonia. The patient’s wife had been hospitalized with pneumococcal pneumonia 2 days earlier. The day after his ED visit, the patient underwent the previously arranged ambulatory PET-CT that revealed a significant increase of fluorine-18-fluorodeoxyglucose (F18-FDG) uptake in the hypopharyngeal mass (thick arrow Fig. 1a), diffuse uptake in the bone marrow of the spine, ribs, and pelvis without underlying bone lesions on a computed tomography (CT scan) (black arrows Fig. 2a–c), and an increased uptake in the right lower lobe consolidation consistent with pneumonia (white arrows Fig. 2b, c). The diagnosis of pneumonia was supported by significant