风湿热：FDG PET/CT 探测到不明原因发热的一种被遗忘但仍然存在的病因。

Rheumatic fever: a forgotten but still existing cause of fever of unknown origin detected on FDG PET/CT.

机构信息

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.

出版信息

Clin Nucl Med. 2015 Mar;40(3):250-2. doi: 10.1097/RLU.0000000000000619.

DOI:10.1097/RLU.0000000000000619

PMID:25546214

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.

摘要

我们报告了 1 例 HIV 阳性患者，其表现为持续 6 个月的湿性咳嗽、发热、体重减轻和进行性呼吸困难，18F-FDG PET/CT 显示心肌和瓣膜摄取 18F-FDG 不均匀且明显增加。增强 CT 未发现发热原因，但超声心动图显示瓣膜回声增强病变，结合 PET/CT 结果提示心内膜炎/心肌炎。PET/CT 后 3 周的尸检组织学显示阿绍夫小体伴阿尼希克（Anitschkow）细胞，这是风湿性心脏病的特征性表现。该病例说明 18F-FDG PET/CT 可检测到风湿性心脏病，并证明了 18F-FDG PET/CT 在不明原因发热患者中的价值。