Han Yeon-Hee, Hwang Joo-Hee, Lee Chang-Seop
Department of Nuclear Medicine, Molecular Imaging & Therapeutic Medicine Research Center, Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School and Hospital, Jeonju, Jeonbuk, Republic of Korea.
Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University -Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School and Hospital, 567 Baekje-daero, Jeonju, Jeonbuk 54907, Republic of Korea.
Radiol Case Rep. 2021 Jul 22;16(9):2754-2756. doi: 10.1016/j.radcr.2021.06.066. eCollection 2021 Sep.
Scrub typhus is an acute febrile disease caused by the intracellular organism The main pathogenesis is focal or disseminated multi-organ vasculitis caused by the infection of endothelial cells and the perivascular infiltration of leukocytes. Many studies have reported interstitial pneumonia, cholecystitis, pancreatitis, and meningoencephalitis in scrub typhus. However, there is no report about sialoadenitis in a patient with scrub typhus. A 79-year-old man was admitted to the emergency room due to a high fever, headache, and myalgia. Scrub typhus was confirmed based on the indirect immunofluorescence assay and the nested polymerase chain reaction. He suffered from severe dry mouth and underwent Tc-99m pertechnetate salivary scintigraphy. While the radiopharmeceutical uptake of the bilateral parotid and submandibular glands was within normal range, salivary excretion into the oral cavity was markedly decreased. After the proper antibiotic treatment, salivary scintigraphy was performed again. Radioactivity in the oral cavity was increased and the ejection fraction (%) after using sialogogue was also improved to the normal range. As far as we know, this is the first report to show salivary scintigraphy of a patient with scrub typhus. By using a Tc-99m pertechnetate salivary scintigraphy, we found that the excretory function of salivary glands was markedly decreased, while the uptake ability was preserved in scrub typhus, unlike Sjögren's syndrome and radiation-induced xerostomia. Salivary scintigraphy presents dry mouth objectively and provides quantitative values as well. Salivary scintigraphy could contribute to the assessment of sialoadenitis before and after treatment of scrub typhus.
恙虫病是由细胞内病原体引起的一种急性发热性疾病。主要发病机制是内皮细胞感染及白细胞血管周围浸润导致的局灶性或播散性多器官血管炎。许多研究报道了恙虫病患者出现间质性肺炎、胆囊炎、胰腺炎和脑膜脑炎。然而，尚无关于恙虫病患者涎腺炎的报道。一名79岁男性因高热、头痛和肌痛入住急诊室。基于间接免疫荧光试验和巢式聚合酶链反应确诊为恙虫病。他患有严重口干，并接受了99m锝高锝酸盐唾液闪烁显像检查。虽然双侧腮腺和颌下腺的放射性药物摄取在正常范围内，但唾液向口腔的排泄明显减少。经过适当的抗生素治疗后，再次进行唾液闪烁显像检查。口腔内的放射性增加，使用催涎剂后的射血分数(%)也提高到正常范围。据我们所知，这是首次报道恙虫病患者的唾液闪烁显像检查。通过99m锝高锝酸盐唾液闪烁显像检查，我们发现恙虫病患者唾液腺的排泄功能明显降低，而摄取能力得以保留，这与干燥综合征和放射性口干不同。唾液闪烁显像能客观呈现口干情况并提供定量数值。唾液闪烁显像有助于评估恙虫病治疗前后的涎腺炎情况。
