Unexpected Diagnosis of Acute Pyelonephritis as a Cause in Neonatal Osteomyelitis and Septic Arthritis Using Ga-67 Citrate Scintigraphy

Bone scintigraphy is a sensitive tool for the early diagnosis of osteomyelitis. However, bone scans can show reduced or normal accumulation of the radiotracer, particularly in neonatal osteomyelitis. In the presence of a normal bone scan but a clinical suggestion of osteomyelitis, Ga-67 citrate may be helpful in the diagnosis of bone infection and its possible origin in distant organs. The authors describe a neonate with acute osteomyelitis of the humerus and septic arthritis of the shoulder with a nondiagnostic bone scan and positive Ga-67 citrate scan. The latter simultaneously demonstrated the humerus osteomyelitis and its previously undiagnosed origin—an infected kidney (acute pyelonephritis).