Fig. 2
From: FDG-PET/CT in intensive care patients with bloodstream infection
A 10-year-old girl known with acute lymphocytic leukemia was admitted to the hospital because of fatigue and general malaise. During admission, the patient also developed fever, for which blood cultures were taken and cefuroxime was started. Blood cultures were positive for Candida albicans. A thoracic X-ray showed small bilateral pulmonary consolidations (a, yellow arrows), and thoracic CT showed multifocal opacities as well (b, red arrows), supporting the diagnosis of pulmonary candidiasis. Voriconazole and caspofungin were started, and a venous access point of the patient was removed because of potential colonization. Despite antifungal treatment, the patient remained febrile, with a CRP level of 61 mg/L and leukocyte count of 23.6 × 109/L. FDG-PET/CT was performed to evaluate other potential foci of infection. Coronal maximum intensity projection FDG-PET showed multiple small subcutaneous and intramuscular FDG avid foci (C, green arrows), and diffuse high FDG uptake in the esophagus (c, dashed green rectangle), suggestive of generalized candidiasis. Small FDG avid pulmonary consolidations were also visible on fused FDG-PET/CT (D, white arrows) as well as high FDG uptake in the esophagus (d, dashed white rectangle), and small subcutaneous and intramuscular FDG avid foci (E, blue arrows). Intensive antifungal therapy was continued, and the patient slowly recovered. The patient was discharged from the hospital 6 weeks after FDG-PET/CT