Gallium Detection of Salmonella

A case of Salmonella costochondritis developed at a traumatic focus in a 37-yr-old Hispanic male without hemoglobinopathy or systemic disease. Bone scans and gallium scans were initially positive and remained abnormal, despite a variable clinical course and repeatedly negative serology and blood cultures. Scintigraphy was valuable for both detection and monitoring of antibiotic treatment, as well as providing localization for subsequent surgical resection. J NucÃ-Med 29:2004-2007,1988 steomyelitis remains a dilemma for clinicians, frequently presenting with nonspecific symptoms and delayed radiographie findings. Numerous articles have described the efficacy of bone and gallium scintigraphy in the diagnosis and treatment of osteomyelitis. Both are sensitive early in acute osteomyelitis, while a sub sequently negative gallium scan provides strong evi dence against persistent bactériologieinfection follow ing antibiotic therapy (1-3). Soft-tissue inflammation also may be detected with radiopharmaceuticals. Gallium-67 (67Ga)has been ex tensively employed for the diagnosis of a variety of inflammatory lesions. Accumulation at inflammatory foci is apparently multifactorial and involves: an ade quate blood supply, increased capillary permeability, direct uptake by leukocytes and bacteria, and binding to lactoferrin and bacterial siderophores (4). Although technetium-99m (99mTc)phosphate uptake has also been reported in many different inflammatory disor ders, the precise mechanisms of localization remain poorly understood. Hyperemia, altered capillary perme ability, adsorption onto soft-tissue calcium, binding by tissue enzyme receptors, tagging to denatured proteins, the presence of soft-tissue iron deposits, and adsorption onto immature collagen all have been postulated, how ever, no single explanation has gained universal accept ance (5). The utilization of both radiopharmaceuticals has been reported in Tietze's syndrome or nonpyogenic costochondritis (6,7). This common clinical entity i