title: False Negative (99m)Tc-Hydroxymethane Diphosphonate Three-phase Bone Scintigraphy and (99m)Tc-besilesomab Scan in Detecting Tibia Osteomyelitis Concomitant with Necrotizing Fasciitis.
abstract: We described a case of 51-year-old female patient presented with a right calf necrotising fasciitis (NF) where osteomyelitis (OM) was suspected. (99m)Tc-hydroxymethane diphosphonate three-phase bone scintigraphy and (99m)Tc-besilosomab scan failed to demonstrate classical features of OM. The final diagnosis was only made by isolating Acinetobacter sp. in both intra-operative bone and tissue cultures from below-knee amputation. As conclusions, the detection of lower limb OM by (99m)Tc-besilosomab scan is not easy when there is concurrence overlying NF. The unusual three-phase bone scan finding of pericortical accumulation of tracer as an early sign of OM is highlighted in this case.
authors.affiliation: Department of Nuclear Medicine, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia.
authors.forename: Teik Hin
authors.initials: TH
authors.lastname: Tan
authors.affiliation: Department of Nuclear Medicine, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia.
authors.forename: Boon Nang
authors.initials: BN
authors.lastname: Lee
keywords: 99mTc-besilosomab scan; 99mTc-hydroxymethane diphosphonate three-phase bone scintigraphy; necrotising fasciitis; osteomyelitis