Tc-99m-labeled leukocyte and skeletal scintigraphy in a case of pelvic osteomyelitis

Osteomyelitis in red marrow-containing regions of the axial skeleton may produce photopenic defects on radiolabeled leukocyte scintigraphy. A 47- year-old man underwent elective penile reconstructive surgery. The postoperative course was complicated by wound infection, and the patient reported progressive anterior pelvic pain despite antibiotic therapy. A Tc- 99m MDP bone scan revealed focal hyperemia and increased tracer uptake in the body of the pubis and pubic crest bilaterally, suspicious for regional osteomyelitis. A Tc-99m stannous colloid-labeled leukocyte study performed subsequently showed absent white cell accumulation in the corresponding area, with a normal pattern of distribution elsewhere in the skeleton. Bone biopsy from the pubic symphysis demonstrated a neutrophilic cellular infiltrate and granulation tissue consistent with active bony infection.