Positively labeled white blood cell scan with eosinophilia and absence of infection.
OBJECTIVE
The authors describe the variability of Tc-99m exametazime-labeled leukocyte distribution as a function of the relative frequency of white cell types in the labeled blood.


METHODS
A 76-year-old man who was hospitalized with fever and possible postoperative osteomyelitis underwent scintigraphic imaging with Tc-99m exametazime-labeled leukocytes.


RESULTS
The white cell scan excluded any discrete focus of infection and revealed diffuse involvement of the lymph nodes and skin. The pathologic diagnosis was angioimmunoblastic T-cell lymphoma. The atypical infiltrates seen on the white cell scan can be explained by the severe eosinophilic blood count on the day of leukocyte labeling (total leukocyte count: 8,100 cells/microl with 63% neutrophils, 8.9% lymphocytes, and 22.2% eosinophils).


CONCLUSIONS
In the labeling of the leukocyte moiety, a higher presence of any leukocyte subpopulation will modify the biodistribution and thus the image interpretation.
Vasanawala
Minal S
MS
Division of Nuclear Medicine, Stanford University, California 94305, USA.
Goris
Michael L
ML
D000368:Aged; D003937:Diagnosis, Differential; D004802:Eosinophilia / Q000209:etiology / Q000473:pathology; D005335:Fever of Unknown Origin / Q000209:etiology; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects; D007962:Leukocytes / Q000000981:diagnostic imaging*; D016399:Lymphoma, T-Cell / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging* / Q000209:etiology; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime; D014915:Whole-Body Counting / Q000379:methods*
D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime