Imaging in plague

An 8-year-old boy presented with elevated temperature, malaise, hepatosplenomegaly, mesenteric adenitis, and septic shock. Cultures of biopsied abdominal lymph nodes as well as the blood grew Yersinia pestes. The boy's condition improved after two weeks of chloramphenicol and cefotaxime (Claforan). Two days after stopping intravenous antibiotic therapy, the patient again became febrile and complained of abdominal pain. Abdominal imaging with IIIIn labeled leukocytes did not show any abnormalities, however, 67Ge-citrate scintigraphy demonstrated an abnormal focus of increased radiopharmaceutical uptake within a confluence of necrosed lymph nodes with the right upper quadrant of the abdomen. In addition, abnormal 67Ga uptake was seen within the left hip region. Correlative imaging with computed tomography is also presented. (orig.)