Diagnosis of aortic graft infection by 18-F-fluorodeoxyglucose positron emission tomography in a hemodialysis patient

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  • 内シャント刺入部感染による胸腹部大動脈人工血管感染をＦＤＧ‐ＰＥＴにより診断しえた１症例
  • 症例報告 内シャント刺入部感染による胸腹部大動脈人工血管感染をFDG-PETにより診断しえた1症例
  • ショウレイ ホウコク ナイ シャントシニュウブ カンセン ニ ヨル キョウ フクブ ダイドウミャク ジンコウ ケッカン カンセン オ FDG PET ニ ヨリ シンダン シエタ 1 ショウレイ

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Abstract

A 50-year-old patient underwent hemodialysis for chronic renal failure due to autosomal dominant polycystic kidney disease for 5 years. Six years previously, thoracico-abdominal graft surgery was performed for acute aortic dissection. He was hospitalized for examination of fever of unknown origin (FUO) persisting for one month. Methicillin-susceptible Staphylococcus aureus (MSSA)was detected by blood culture, but conventional imaging techniques such as body CT and ultrasonography could not detect the focus of infection. However, 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) definitively identified the foci of increased FDG uptake in the aortic graft, leading to a diagnosis of aortic graft infection by MSSA. Pan-prosthetic aortic graft infection is a life-threatening complication, and the traditional surgical therapy requiring total graft excision and extra-anatomic reconstruction is thought to be associated with high morbidity and mortality. Therefore, the patient was treated with long-term antibiotics without graft removal and pyrexia was finally improved a few months later. Generally, 18F-FDG accumulates not only in malignant tissues but also at sites of infection and inflammation due to the increased metabolic rate both in cancer cells and inflammatory cells. Therefore, it was demonstrated that FDG-PET is useful for detecting infections as well as malignant tumors. Hemodialysis patients are susceptible to various kinds of infectious diseases causing FUO due to their immunodeficiency. Moreover, it is difficult to diagnose such patients due to their atypical symptoms and lower positivity rates on various examinations. As demonstrated in the present case, FDG-PET could become a promising tool for evaluating FUO in hemodialysis patients.

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