Keywords
18F-prostate-specific membrane antigen - COVID-19 - infection - positron emission tomography
computed tomography - prostate cancer
Introduction
The COVID-19 pandemic has now reached most countries. Emergency room and intensive
care staff are at increased risk for infection, however, the referred patients to
a nuclear medicine department will be primarily the asymptomatic ones. Therefore,
good communication with referral physicians and safety measures are mandatory for
the protection of other patients and staff.[1],[2]
In a recent publication, it was suggested that 18F-fluorodeoxyglucose positron emission tomography computed tomography (PET-CT) can
identify COVID-19 cases in the absence or before symptom onset and may guide patient
management.[3]
Case Report
We report the case of a patient (84-year-old male) who was sent for 18F-prostate-specific
membrane antigen (PSMA) PET-CT with suspicion of recurrent disease after prostate
cancer and total prostatectomy 2 years prior to the examination. The patient suffered
from COVID-19 pneumonia 4 weeks prior to PET-CT examination.
The examination was performed as elsewhere described.[4] Briefly, PET-CT images were performed 1 h after intravenous injection of 248 MBq18F-PSMA
on a PET-CT scanner (Siemens Healthineers, Erlangen) and the images were analyzed
on a Syngovia Workstation (Siemens Healthineers, Erlangen). The 18F-PSMA PET-CT revealed moderate elevated uptake in the area of previous pneumonia
as shown in [Figure 1]. The patient had no respiratory symptoms and no other signs of infection at the
time of PET examination. The radiological findings showed ground glass changes in
this area. These pulmonary findings were interpreted as remaining inflammatory changes
in an already recovered patient after Covid-19 infection, as it has been ascribed
to PSMA uptake in inflammation elsewhere.[5]
Figure 1
18F-prostate-specific membrane antigen positron emission tomography computed tomography
(84y, male) displays a diffuse moderate uptake in the right lung (SUVmax 2.6), in topographic correlation to ground glass opacities consistent with residual
inflammation (black arrows), 4 weeks after COVID-19 infection
Conclusion
To the best of our knowledge, this is the first case report with a pathological pulmonary
uptake of a PSMA ligand with PET-CT in COVID-19 patients, indicating possible residual
inflammatory disease even weeks after infection.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms.
In the form, the patient(s) has/have given his/her/their consent for his/her/their
images and other clinical information to be reported in the journal. The patients
understand that their names and initials will not be published and due efforts will
be made to conceal their identity, but anonymity cannot be guaranteed.
