Home » AGEB Journal » Issues » Volume 86 » Fasc.1 - Case reports

Volume 86 - 2023 - Fasc.1 - Case reports

The pitfalls of 68Ga-DOTATATE Imaging. A case report

Neuroendocrine tumors (NETs) are a heterogeneous group of tumors exhibiting diverse clinical and biological characteristics. Despite the diverse nature of these neoplasms, they share common molecular targets which can be used with the help of nuclear medicine techniques for both imaging and therapy. 68Ga-DOTATATE was approved as a PET tracer by the FDA in June 2016 and allows whole-body imaging of cell surface expression of somatostatin receptors (SSTRs). Since then it has become a functional imaging technique that is a mainstay in the initial diagnostic work-up and staging of NETs. This imaging technique, however, has demonstrated pitfalls which need to be considered. Physiological uptake of 68Ga- DOTATATE occurs in a variety of tissues including the spleen, adrenal glands, kidneys, pituitary glands, liver, salivary glands and thyroid gland. SSTRs are also expressed on leucocytes and macrophages, resulting in inflammatory processes sometimes being misidentified with this imaging technique. We present a case with a radiological image that could be suggestive for a primary neuroendocrine tumor with desmoplastic reaction. 68Ga-DOTATATE showed no remarkable uptake in the central mass, but only faint uptake in the surrounding desmoplastic reaction. The final diagnosis on histological examination, was an inflammatory reaction surrounding biliary pigment.


Olmesartan induced enteropathy affecting the entire gastrointestinal tract: a case report

Olmesartan, a well-known and powerful antihypertensive drug, was first described to cause enteropathy in 2012. A possible mechanism may be inhibition of the intestinal immune suppressive effect of transforming growth factor-beta (TGF-β), with a consequential increase of intestinal T-cell inflammation. We present the case of a 60-year-old woman who developed large volume, watery diarrhoea with 8kg weight loss only two weeks after starting olmesartan 20mg daily with a secondary mild acute kidney insufficiency and hypokalaemia. Coeliac serology was negative. Endoscopy revealed no macroscopic lesions. Histology showed increased gastric, duodenal, ileal and colonic intraepithelial lymphocytes with partial duodenal villous atrophy, hence affecting the entire gastrointestinal tract. After cessation of olmesartan, symptoms improved within a week; therefore a diagnosis of olmesartan induced enteropathy was made. Extra immunohistochemical stains to further investigate the underlying pathophysiology were inconclusive.


A curious presentation of Crohn’s disease with pulmonary involvement: a case report

Crohn’s disease (CD) is a chronic inflammatory bowel disease often presenting with extraintestinal manifestations. However, pulmonary involvement in CD is quite rare. We here report a case of CD with pulmonary manifestation as the first presenting sign. Thus, immune-mediated inflammatory disorders such as CD should always be kept in the differential list in case of unusual clinical symptoms or radiological signs of idiopathic pulmonary presentations.


Olmesartan induced weight loss and small vessel vasculitis

This case report describes a 52-year-old male patient with important weight loss, fatigue, diarrhea and a skin eruption since 1 year. Olmesartan-induced enteropathy and skin vasculitis were diagnosed. The onset of symptoms occurred almost two years after the initiation of the angiotensin receptor blocker therapy. There was a total resolution of the symptoms after the cessation of olmesartan. Although sprue-like enteropathy and cutaneous vasculitis are very rare, clinicians should be aware of those potential adverse events, even years after the initiation of an angiotensin II receptor blocker.