technetium-tc-99m-medronate and Muscle-Weakness

A 33 year old female, suffering from HIV infection, presents with diffuse myalgia, generalized muscle weakness and painless dysphagia. An extensive work-up allows to diagnose an HIV-related polymyositis; while well-known, this entity is however rarely observed. Technetium-99m MDP skeletal scintigraphy shows multiple extra-osseous accumulations of the tracer: these observations, as well as the differential diagnoses of muscular involvement during HIV infection, are discussed.

Topics: Adult; Anti-Inflammatory Agents; Biopsy; Deglutition Disorders; Diagnosis, Differential; Female; HIV Infections; Humans; Muscle Weakness; Pain; Polymyositis; Prednisolone; Technetium Tc 99m Medronate

Topics: Adenine; Alkynes; Anti-HIV Agents; Benzoxazines; Cyclopropanes; Deoxycytidine; Drug Therapy, Combination; Emtricitabine; Fanconi Syndrome; Female; Hepatitis, Viral, Human; HIV Infections; Humans; Hypophosphatemia; Middle Aged; Muscle Weakness; Musculoskeletal Diseases; Organophosphonates; Osteomalacia; Pain; Radionuclide Imaging; Radiopharmaceuticals; Substance Abuse, Intravenous; Technetium Tc 99m Medronate; Tenofovir

Pott's disease is an uncommon extrapulmonary form of tuberculosis. Delay in diagnosis and management may cause serious complications. The authors describe Pott's disease incidentally detected on Tc-99m MDP bone and Ga-67 imaging in a patient with diabetes. Tc-99m MDP bone scintigraphy showed intensely increased uptake in the lower cervical spine and lumbosacral regions. Ga-67 scintigraphy revealed intensely increased uptake corresponding to the areas noted on Tc-99m MDP bone scintigraphy. Magnetic resonance imaging showed destructive lesions in the C5-C6 and L5-S1 intervertebral discs with destruction of adjacent end plates. Biopsy of the lumbosacral area was guided by computed tomography, and histologic examination of the bone specimen showed caseation, giant cells, and acid-fast bacilli. Posterior decompression and posterolateral spinal fusion with bone grafts were performed. Antituberculous chemotherapy with isoniazid, rifampicin, pyrazinamide, and ethambutol was started. The patient showed remarkable relief of symptoms during a period of 9 months of therapy. Both Tc-99m MDP bone and Ga-67 imaging can offer the convenience of screening the entire body to detect multiple sites of Pott's disease.

Topics: Cervical Vertebrae; Citrates; Diabetes Complications; Diabetes Mellitus; Diagnosis, Differential; Female; Gallium; Humans; Hypertension; Incidental Findings; Low Back Pain; Lumbosacral Region; Middle Aged; Muscle Weakness; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tuberculosis, Spinal; Whole-Body Counting

Topics: Adult; Bone Density; Calcitriol; Fatty Acids; Female; Humans; Malabsorption Syndromes; Muscle Weakness; Technetium Tc 99m Medronate; Vitamin D Deficiency; Wheelchairs