Tagiling N, Mohd-Rohani M F, Wan-Sohaimi W F, Faisham W I, Nawi N M
Department of Nuclear Medicine, Radiotherapy and Oncology, Universiti Sains Malaysia, Kubang Kerian, Malaysia.
Nuclear Medicine Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
Malays Orthop J. 2020 Nov;14(3):188-193. doi: 10.5704/MOJ.2011.032.
Megaprosthesis is used to restore the form and function of massive skeletal defects, but it is accompanied by risks of failure, mainly due to perimegaprosthetic infection (PMI). In practice, the diagnosis of infected megaprosthesis among patients with a high index of clinical suspicion, elevated serological markers, and multiple negative or inconclusive imaging can be very challenging and poses a diagnostic conundrum to many orthopaedic surgeons. We present the case of a symptomatic 26-year-old female with large B-cell lymphoma who developed cellulitis with suspected complication of PMI 15 months post-implantation. The combination of advanced nuclear medicine imaging strategies, i.e., Tc-besilesomab/Tc-sulfur colloid scintigraphy with hybrid single-photon emission computed tomography/computed tomography (SPECT/CT) scanning helps to characterise and delineate both infections. Invasive procedures such as joint aspiration and biopsy were avoided, and the patient was successfully treated with antibiotics. Hence, we report a case where advanced imaging modalities were decisive in the investigation of PMI.
巨型假体用于修复大面积骨骼缺损的形态和功能，但它伴随着失败的风险，主要是由于假体周围感染（PMI）。在实际操作中，对于临床怀疑指数高、血清学标志物升高且多次影像学检查为阴性或结果不确定的患者，感染巨型假体的诊断可能极具挑战性，给许多骨科医生带来了诊断难题。我们报告了一例26岁有症状的女性大B细胞淋巴瘤患者，在植入后15个月发生蜂窝织炎，疑似并发PMI。先进的核医学成像策略，即锝标记的贝西莫单抗/锝标记的硫胶体闪烁扫描联合单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）有助于对两种感染进行特征描述和界定。避免了诸如关节穿刺和活检等侵入性操作，患者通过抗生素治疗成功康复。因此，我们报告了一例先进成像方式在PMI调查中起决定性作用的病例。
