PET-CT in Critically Ill Patients: Diagnosing the Unsuspected

Objective: Quick identification of septic source is fundamental in patients with severe sepsis of unknown origin. The purpose of this case report was to assess the benefit and feasibility of an early PET-CT in critically ill patients with undiagnosed sepsis. Data Sources: Clinical observations of two patients. Study Selection: Case reports. Data Extraction: Data extracted from medical records, after patient’s consent. Illustrations were collected from the imaging software. Data Synthesis: We admitted two critically ill patients for suspected sepsis and altered mental state. As all bacteriological samples were initially sterile, diagnostic workups in both patients led us to suspect underlying malignant hemopathy. In fact, the lumbar puncture of the first patient revealed a large B-cell lymphoma, and an acquired thrombotic thrombocytopenic purpura was suspected in the second patient. However, PET-CTs performed in both patients displayed infra-clinical underlying infectious foci. Within 48 hours, both patients developed a clearly identified sepsis linked to the described focus, and favorable outcome thanks to the precious information delivered by the PET-CT. Conclusions: PET-CT precisely detected the deep foci of infection about 48 hours prior to the diagnosis of sepsis. The cases reports suggested the use of this image technique in ICU for patients with sepsis of unknown origin. Dr. Friggeri received funding from Pfizer, MSD, and Sanofi. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: romain.fort@chu-lyon.fr Copyright © by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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