A case of skeletal tuberculosis and psoas abscess: disease activity evaluated using (18) F-fluorodeoxyglucose positron emission tomography-computed tomography.
BACKGROUND
Psoas abscess complicating tuberculous spondylitis is a rare morbidity in extrapulmonary tuberculosis. There are no established guidelines for evaluating the clinical response of psoas abscess. Although several studies have shown that positron emission tomography-computed tomography with 18 F-fluorodeoxyglucose can play a potential role in diagnosing multifocal tuberculosis and monitoring the clinical response of pulmonary tuberculosis, to our knowledge, this is the first report demonstrating that positron emission tomography-computed tomography is useful for evaluating local inflammation and disease activity of a tuberculous psoas abscess.


METHODS
We report a case of multifocal bone and lymph node tuberculosis with concomitant lumbar psoas abscess in a 77-year-old man, along with a literature review. An initial positron emission tomography-computed tomography scan showed intense 18 F-fluorodeoxyglucose accumulation in the sternum, ribs, vertebrae, and lymph nodes. The patient was successfully treated with antitubercular agents and computed tomography-guided drainage therapy. A follow-up positron emission tomography-computed tomography after abscess drainage and 9 months of antitubercular drug treatment revealed that the majority of lesions improved; however, protracted inflammation surrounding the psoas abscess was still observed. These results indicate that disease activity of psoas abscess can remain, even after successful drainage and antitubercular medication regime of appropriate duration.


CONCLUSIONS
We have successfully followed up the extent of skeletal tuberculosis complicated with psoas abscess by positron emission tomography-computed tomography. In this patient, positron emission tomography-computed tomography is useful for evaluating the disease activity of tuberculous psoas abscess and for assessing the appropriate duration of antitubercular drug therapy in psoas abscess.
Yoshifumi
Y
Kimizuka
Division of Pulmonary Medicine, School of Medicine, Keio University, 35 Shinanomachi Shinjuku-ku, Tokyo 160-8582, Japan. ishii@z6.keio.jp.
Makoto
M
Ishii
Koji
K
Murakami
Kota
K
Ishioka
Kazuma
K
Yagi
Ken
K
Ishii
Kota
K
Watanabe
Kenzo
K
Soejima
Tomoko
T
Betsuyaku
Naoki
N
Hasegawa
D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D004322:Drainage; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008297:Male; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D016659:Psoas Abscess / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000382:microbiology; D012272:Ribs / Q000000981:diagnostic imaging; D013131:Spine / Q000000981:diagnostic imaging; D013249:Sternum / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014388:Tuberculosis, Lymph Node / Q000000981:diagnostic imaging; D014399:Tuberculosis, Spinal / Q000150:complications* / Q000000981:diagnostic imaging*
D000995:Antitubercular Agents; D019788:Fluorodeoxyglucose F18