To treat or not to treat tuberculosis -clinical decision making in patients with previous pulmonary tuberculosis using 18F-FDG PET/CT

Gunar Günther; Nebal Abu-Hussain; Peter M Keller; Reto Guler; Sandra L Mukasa; Karen Wolmarans; Friedrich Thienemann

doi:10.1016/j.rmcr.2023.101932

To treat or not to treat tuberculosis -clinical decision making in patients with previous pulmonary tuberculosis using 18F-FDG PET/CT

Respir Med Case Rep. 2023 Oct 19:46:101932. doi: 10.1016/j.rmcr.2023.101932. eCollection 2023.

Authors

Gunar Günther^{1

2}, Nebal Abu-Hussain¹, Peter M Keller³, Reto Guler^{4

5

6}, Sandra L Mukasa^{7

8}, Karen Wolmarans^{7

8}, Friedrich Thienemann^{7

8

9}

Affiliations

¹ Department of Pulmonology and Allergology, Inselspital Bern, Bern University Hospital, University of Bern, Switzerland.
² Department of Medical Sciences, School of Medicine, University of Namibia, Windhoek, Namibia.
³ Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
⁴ International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town Component, Cape Town, South Africa.
⁵ Institute of Infectious Diseases and Molecular Medicine (IDM), Department of Pathology, Division of Immunology, Faculty of Health Sciences, University of Cape Town, South Africa.
⁶ Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town, South Africa.
⁷ General Medicine & Global Health (GMGH), Cape Heart Institute, Faculty of Health Science, University of Cape Town, South Africa.
⁸ Department of Medicine, Faculty of Health Science, University of Cape Town, South Africa.
⁹ Department of Internal Medicine, University of Zürich, Switzerland.

Abstract

Post-tuberculosis (TB) radiological changes and symptoms can mimic TB. PCR-based diagnostic tests can show positive results, suggesting the presence of Mycobacterium tuberculosis DNA in the absence of viable bacteria. We present a case with two episodes of previous TB. Despite workup including trace to low positive PCR results, after performing sputum analysis, bronchoalveolar lavage analysis, cyto-brush and 18F-FDG PET/CT guided transthoracic biopsy, no culturable mycobacteria were detected. 18F-FDG PET/CT showed a high metabolic activity of the biopsied lesions. More accurate strategies and tools in patients with previous TB and positive PCR results are required to make appropriate treatment decisions.

Keywords: 18F-FDG PET/CT; False-positive; Tuberculosis; recurrent.

Publication types

Case Reports