From the 1 Department of Cardiology.
Infect Dis (Lond). 2015 Apr;47(4):263-6. doi: 10.3109/00365548.2014.984323. Epub 2015 Jan 23.
We present a 54-year-old woman with systemic lupus erythematosus (SLE), fever, pericardial effusion and a mitral valve vegetation. (18)F-Fluorodesoxyglucose positron emission tomography CT ((18)F-FDG-PET-CT) showed very high accumulation of the isotope at the mitral valve. The patient underwent cardiothoracic surgery and pathologic examinations showed characteristic morphology of Libman-Sacks vegetations. All microbiological examinations including blood cultures, microscopy, culture and 16s PCR of the valve were negative and the diagnosis of Libman-Sacks endocarditis was convincing. It is difficult to distinguish Libman-Sacks endocarditis from culture-negative infective endocarditis (IE). Molecular imaging techniques are being used increasingly in cases of suspected IE but no studies have previously reported the use in patients with Libman-Sacks endocarditis. In the present case, (18)F-FDG-PET-CT clearly demonstrated the increased glucose uptake caused by infiltrating white blood cells in the ongoing inflammatory process at the mitral valve. In conclusion, (18)F-FDG-PET-CT cannot be used to distinguish between IE and non-infective Libman-Sacks vegetations.
我们报告了 1 例系统性红斑狼疮（SLE）、发热、心包积液和二尖瓣赘生物的 54 岁女性患者。（18）F-氟代脱氧葡萄糖正电子发射断层扫描 CT（（18）F-FDG-PET-CT）显示同位素在二尖瓣处高度聚集。患者接受了心胸外科手术，病理检查显示出典型的 Libman-Sacks 赘生物形态。所有微生物学检查，包括血培养、显微镜检查、瓣膜培养和 16s PCR 均为阴性，因此明确诊断为 Libman-Sacks 心内膜炎。Libman-Sacks 心内膜炎与培养阴性的感染性心内膜炎（IE）很难区分。分子成像技术在疑似 IE 的病例中越来越多地被使用，但以前没有研究报道在 Libman-Sacks 心内膜炎患者中的应用。在本病例中，（18）F-FDG-PET-CT 清楚地显示了二尖瓣持续炎症过程中浸润的白细胞导致的葡萄糖摄取增加。总之，（18）F-FDG-PET-CT 不能用于区分 IE 和非感染性 Libman-Sacks 赘生物。
