[Pulmonary aspergillosis as initial manifestation of septic granulomatosis (chronic granulomatous disease, CGD) in a premature monozygotic female twin and FDG-PET diagnosis of spread of the disease].
OBJECTIVE
To present the unusual case of chronic granulomatous disease (CGD) manifestating as pulmonal aspergillosis in female enzygotic twins during the neonatal period. To demonstrate and to discuss the complex diagnosis and the diagnostic value of FDG-PET in monitoring the spread and activity of the disease.


METHODS
Plain chest x-ray and CT of the lung showed multiple, mostly round lesions in one of the former preterm twins at the age of 8 weeks. The girl with known ASD II was then suffering from dyspnoea and recurrent pulmonary infections. Because of the imaging findings invasive pulmonary aspergillosis due to an underlying immunodeficiency was suspected.


RESULTS
Aspergillosis was confirmed histologically and microbiologically by specimens taken from an open lung biopsy. Because of coexisting granulocytic dysfunction the diagnosis of CGD was made. This diagnosis was equally confirmed by noninvasive methods in the asymptomatic sister. FDG-PET did not show any evidence of extra-pulmonary spread of disease.


CONCLUSIONS
CGD can present as isolated pulmonal aspergillosis even in the neonatal period when an immunodeficiency is discussed. In enzygotic twins screening of the asymptomatic twin is mandatory. FDG-PET is a useful tool in screening for spread of the disease and in evaluating disease activity.
Theobald
Iris
I
Institut für Klinische Radiologie des UKM, Albert Schweitzer Str. 33, 48129 Münster.
Fischbach
R
R
Hülskamp
G
G
Franzius
Christiane
C
Frosch
M
M
Roth
J
J
Heindel
W
W
D000367:Age Factors; D001228:Aspergillosis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002585:Cesarean Section; D004200:Diseases in Twins; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006105:Granulomatous Disease, Chronic / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000000981:diagnostic imaging; D013902:Radiography, Thoracic; D019275:Radiopharmaceuticals; D013997:Time Factors; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed; D014430:Twins, Monozygotic
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
Pulmonale Aspergillose als Erstmanifestation einer septischen Granulomatose (chronic granulomatous disease, CGD) bei eineiigen weiblichen Zwillingsfrühgeborenen und Ausbreitungsdiagnostik mittels FDG-PET.