sodium-pertechnetate-tc-99m and Sarcoma--Kaposi

The value of immunoscintigraphy with technetium-99m (99Tcm) labelled anti-granulocyte monoclonal antibody (BW250/183) was studied prospectively in human immunodeficiency virus (HIV-1) antibody-positive patients presenting with fever without localizing symptoms or signs. Twenty-three studies were performed in 23 patients and the results of 99Tcm-anti-granulocyte imaging were compared with the definitive microbiological or cytological diagnosis. Twenty-one patients had an infective cause of pyrexia, one patient had disseminated lymphoma and one Kaposi sarcoma. 99Tcm-anti-granulocyte antibody imaging correctly identified the sites of infection in only five (24%) patients, four of whom had infective colitis (one also had bacterial pneumonia) and one of whom had cellulitis. Sixteen foci of infection were not localized by 99Tcm-anti-granulocyte immunoscintigraphy (false-negative scans). Six of these patients had Pneumocystis carinii pneumonia; other diagnoses in this group included bacterial or fungal pneumonia and bacteraemia secondary to line infections. 99Tcm-anti-granulocyte antibody did not accumulate in the patients with disseminated lymphoma and Kaposi sarcoma (true-negative scans). 99Tcm-anti-granulocyte imaging, therefore, appears useful in identifying extrathoracic infection in HIV-1 positive patients. Its lack of sensitivity for the identification of pulmonary infection means that its role in the investigation of HIV-1 antibody-positive patients with fever without localizing symptoms or signs is limited.

Topics: Adult; AIDS-Related Opportunistic Infections; Antibodies, Monoclonal; Antibody Specificity; Bacterial Infections; False Negative Reactions; False Positive Reactions; Fever of Unknown Origin; Granulocytes; HIV Infections; Humans; Immunoconjugates; Lung Neoplasms; Lymphoma, AIDS-Related; Male; Middle Aged; Mycoses; Pneumonia; Pneumonia, Pneumocystis; Prospective Studies; Radioimmunodetection; Sarcoma, Kaposi; Sodium Pertechnetate Tc 99m; Virus Diseases

Kaposi's sarcoma and pseudo-Kaposi's arteriovenous malformation differ greatly in cause, evolution, prognosis, and treatment; yet their clinical macroscopic manifestations are similar. A simple and safe method of distinguishing between them is described.

Topics: Arteriovenous Malformations; Diagnosis, Differential; Humans; Leg; Radionuclide Imaging; Sarcoma, Kaposi; Sodium Pertechnetate Tc 99m

A total of 13 technetium 99m (99mTc) pertechnetate image studies were performed on 7 patients with a histologic diagnosis of Kaposi's sarcoma. Five patients with peripheral edema had diffusely increased radionuclide activity in the same areas. The two patients without edema had normal radionuclide images. The primary cutaneous lesions were only identified in one of the patients. These findings suggest that previously reported "occult metastasis" are probably due to peripheral edema in most patients; therefore, the radionuclide study has a much lower sensitivity than has been previously reported.

Topics: Aged; Edema; Evaluation Studies as Topic; Humans; Middle Aged; Radionuclide Imaging; Sarcoma, Kaposi; Sodium Pertechnetate Tc 99m

The clinical picture of ulcerated purple plaques on the legs often suggests several diagnoses: Kaposi's sarcoma, stasis dermatitis, atrophie blanche (livedoid vasculitis), and a poorly understood condition called acroangiodermatitis of Favre-Chaix (pseudo-Kaposi's sarcoma). Even the skin biopsy may not always be conclusive. We describe our experience with three patients with pseudo-Kaposi's sarcoma, one with "true" Kaposi's sarcoma and two with atrophie blanche. Clinical and histopathologic similarities among these three conditions pointed up the need for additional confirmatory studies, i.e., isotope scanning. The technetium scan was positive in both Kaposi's sarcoma and pseudo-Kaposi's sarcoma but negative in atrophie blanche.

Topics: Acrodermatitis; Adult; Aged; Diagnosis, Differential; Female; Humans; Male; Radionuclide Imaging; Sarcoma, Kaposi; Skin; Skin Neoplasms; Sodium Pertechnetate Tc 99m; Syndrome; Technetium; Vascular Diseases; Vasculitis