key: cord-0953626-v0f7ghy5
authors: Zamora, Edgar; Valdivia, Ana Y.; Zalta, Benjamin; Zuckier, Lionel S.
title: [67Ga] Ga-citrate and COVID-19-associated pneumonia: an unexpected absence of uptake
date: 2020-06-13
journal: Eur J Nucl Med Mol Imaging
DOI: 10.1007/s00259-020-04886-9
sha: 54eb87f292434680a70b52bb90478575ee7394ff
doc_id: 953626
cord_uid: v0f7ghy5

nan

Tc-MDP bone scan demonstrated increased right mastoid uptake; gallium scintigraphy performed at 48 h demonstrated overall normal biodistribution with focal intense mastoid uptake (planar, top transaxial images). Extensive typical COVID-19-related lung infiltrates were noted on SPECT/CT; more diffuse than on prior bone scintigraphy but associated with very minimal gallium activity (planar, lower transaxial images). The patient succumbed from COVID-19 complications 11 days following the gallium imaging.

The finding of worsening COVID-19-related pneumonia with negligible gallium uptake contrasts with our observation of gallium's effectiveness to identify mastoid bone suppuration and may relate to differences in pathogen (virus vs. bacteria), substrate (lung vs. bone), or nature of pathology (suppurative vs. ARDS-like process). Minimal lung uptake also strikingly differs from the relatively intense lung uptake reported with FDG [2] [3] [4] . Further exploration of differences in the molecular basis of gallium and FDG localization, and variation in the pathophysiology of mastoiditis and COVID-19related lung pathology, will help shed light on these observations. From a clinical perspective, while gallium scintigraphy is often regarded as a generally sensitive tool to identify infectious processes in the lungs [5] , it appears that COVID-19related lung lesions may not be included in this blanket generalization.

This article is part of the Topical Collection on Image of the month Human Research Ethics Committee (HREC) is not required for case reports in the USA nor at the authors' institution. Patient's age and other identifying features have been redacted to protect patient anonymity.

Conflict of interest The authors declare that they have no conflicts of interest and have not received any type of funding related to this work.

Ethics approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. No studies involving animals are described in this article.

Patient Consent Patient identity in this retrospective single case report has been fully anonymized to comply with privacy standards.

Malignant external otitis: early scintigraphic detection

18)F-FDG PET/CT findings of COVID-19: a series of four highly suspected cases

FDG PET/CT of COVID-19

FDG-PET/CT findings highly suspicious for COVID-19 in an Italian case series of asymptomatic patients

Gallium and other agents in diseases of the lung