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Year : 1999  |  Volume : 9  |  Issue : 1  |  Page : 19-20
Case report : Diagnosis and follow up of hip prosthesis infection using TC-99m ciprofloxacin

1 Department of Nuclear Medicine, Institute of Nuclear Medicine and Allied Sciences, New Delhi, India
2 Dept of Orthopaedics, Base Hospital, New Delhi, India

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Keywords: Tc-99m ciprofloxacin, Osteomyelitis, Diagnosis

How to cite this article:
Bhatnagar A, Singh B K, Kashyap R, Gera A, Chopra MK. Case report : Diagnosis and follow up of hip prosthesis infection using TC-99m ciprofloxacin. Indian J Radiol Imaging 1999;9:19-20

How to cite this URL:
Bhatnagar A, Singh B K, Kashyap R, Gera A, Chopra MK. Case report : Diagnosis and follow up of hip prosthesis infection using TC-99m ciprofloxacin. Indian J Radiol Imaging [serial online] 1999 [cited 2020 Sep 26];9:19-20. Available from:
Diagnosis of an occult site of infection is a vexing clinical problem. The dilemma is worse in an infected prosthesis where radiology may be negative well into the chronic phase. Bone scan is generally unable to provide a definitive diagnosis because the tracer avidly concentrates at the site of loosening, infection or bone degeneration. We present here a patient with hip prosthesis infection where radionuclide scanning done thrice with Tc-99m ciprofloxacin (Tc-99m Infection) was able to localize the occult site of infection. We also present the follow-up treatment and the patient's response, over a period of time.

   Case Report Top

A 38 years-old man with rheumatoid arthritis went into remission after a course of methotrexate. The patient developed avascular necrosis of both the hips for which bilateral hip replacement [Figure - 1] was done two years earlier. After a few months, an abscess burst in the upper lateral aspect of the right thigh, the path of which was traced to the trochanteric area by a sinogram. The pus culture was positive for S. aureus, which is sensitive to ciprofloxacin, among other antibiotics. Biopsy of the tract was consistent with non-specific inflammation. The tract became active periodically. A bone scan and Tc-99m ciprofloxacin scan were performed six months earlier when the tract was almost inactive, the patient afebrile, and the blood profile normal.

The bone scan showed no abnormal uptake in the asymptomatic left hip. The right hip prosthesis had foci of non-specific uptake around the acetabular portion, trochanteric region and at its lower end. The Tc-99m ciprofloxacin scan was performed at one and four hours after injecting 12 mCi of the tracer. It showed abnormal uptake only around the acetabular portion of the right hip [Figure - 2]a. There was no uptake in the other lesions seen on the bone scan suggesting these to be loosening/degenerated lesions. There was no uptake in the sinus tract suggesting it to be just a conduit for the pus and not infected in itself.

The patient again developed discharge from the sinus site, which dried up after few weeks of an antibiotic regime. Tc-99m ciprofloxacin study done this time on antibiotic cover [Figure - 2]b was considered normal. The study was repeated when pus discharge reappeared and this time the abnormal uptake was localized to the lateral margin of the prosthetic ball [Figure - 2]c. This focus correlated exactly with the placement of the outer acetabular nail [Figure - 1]. Culture grown from the pus again showed S. aureus infection. The patient has been now put on a rifampicin-based regime and surgical lavage of the right hip is being contemplated.

   Discussion Top

Almost all the radiotracers available today are inflammation specific and not infection-specific. Tc-99m ciprofloxacin (Tc-99m Infection) was introduced recently by Solanki et al for imaging bacterial infection [1]. It was found to be clinically safer, cost effective and more accurate than conventional leucocyte imaging in more than 100 patients [2],[3]. The images obtained with it were superior to labeled leucocytes. In-vitro experiments have shown that it concentrates only in live bacteria and not in sterile pus [2]. Another advantage of using this tracer is that it concentrates in bacterial populations resistant to the parent antibiotic. Our experience also suggests it to be more specific than Tc-99m MDP bone scanning for diagnosing osteomyelitis [4]. We have used it in more than 40 patients till date and have not seen any untoward reaction. The findings in this case suggest that Tc-99m ciprofloxacin is useful in the diagnosis as well as in the monitoring of treatment response of osteomyelitis. Though the kit for preparing Tc-99m Infection is at present imported, our institute has been able to develop the methodology of the kit preparation indigenously. It appears therefore, that Tc-99m ciprofloxacin imaging may have a definite role in the management of osteomyelitis, a disease much prevalent in the subcontinent.

   References Top

1.Solanki K, Bomanji J, Siraj Q et al. Tc-99m Infection: a new class of radiopharmaceuticals for imaging infection. J Nucl Med 1993; 34: 119   Back to cited text no. 1    
2.Vinjamuri S, Hall AV, Solanki KK et al. Comparison of 99m Tc-Infection with radiolabelled white-cell imaging in the evaluation of bacterial infection. Lancet 1996; 347: 233-235.   Back to cited text no. 2    
3.Vinjamuri S, Hall AV, Solanki KK et al. Use of 99m Tc-Infection for localizing bacterial infection: clinical evaluation in 102 studies. In press.   Back to cited text no. 3    
4.Bhatnagar A, Taneja NK, Jain CM et al. Imaging bone infection using Tc-99m Infection. Ind J Nucl Med 1997; 12: 8-11.  Back to cited text no. 4    

Correspondence Address:
Aseem Bhatnagar
Department of Nuclear Medicine, Institute of Nuclear Medicine and Allied Sciences, New Delhi 110 054
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Source of Support: None, Conflict of Interest: None

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