title: Rheumatic fever: a forgotten but still existing cause of fever of unknown origin detected on FDG PET/CT.
abstract: We present a case of heterogeneous and strongly increased myocardial and valvular 18F-FDG uptake on 18F-FDG PET/CT in an HIV-positive patient with productive cough, fever, weight loss, and progressive dyspnea for 6 months. Contrast-enhanced CT did not reveal the cause of fever, but hyperechogenic valvular lesions on echocardiography in combination with PET/CT findings are suggestive of endocarditis/myocarditis. Postmortem histology 3 weeks after PET/CT showed Aschoff bodies with Anitschkow cells, pathognomonic for rheumatic carditis. This case illustrates that rheumatic heart disease can be detected on 18F-FDG PET/CT and demonstrates the value of 18F-FDG PET/CT in patients with fever of unknown origin.
authors.affiliation: From the Departments of *Nuclear Medicine, and †Infectious Diseases, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa; and ‡Department of Nuclear Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: Mike
authors.initials: M
authors.lastname: Sathekge
authors.forename: Anton
authors.initials: A
authors.lastname: Stoltz
authors.forename: Olivier
authors.initials: O
authors.lastname: Gheysens
mesh_terms: D005335:Fever of Unknown Origin / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012214:Rheumatic Heart Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18