Diagnosis of infection in a patient with implantable device with (18)F-FDG PET-CT.

We report the case of a 19-year-old woman with a bicameral implantable cardioverter defibrillator. Six months later, she complainted of local discomfort, swelling and pain in the sternotomy scar, without erythema, drainage or fever. She was referred to the Nuclear Medicine Department for evaluation of an inflammatoryinfectious process. An 18F-FDG PET-CT was performed, showing intense uptake in the generator pocket, along the path of the subcutaneous electrode and the deepest portion of extracardiac electrode. No pathological intracardiac uptake in the electrode and valves were observed. Since the metal may cause artefacts in the PET due to overcorrection, we compared the corrected and the uncorrected images, observing persistence of the uptake with similar intensity to those displayed in the corrected PET image; compatible with active inflammatory-infectious disease in the bag and the electrodes, discarding endovascular and valvular infection. The generator and the two electrodes were explanted and a new device was implanted. Cultures of the explanted electrodes and the bag’s tissue showed growth of Staphylococcus epidermidis and Propionibacterium acnes, confirming local infection of the removed material, consistent with the findings of PET-CT.