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Positively Labeled White Blood Cell Scan with Eosinophilia and Absence of Infection

Purpose The authors describe the variability of Tc-99m exametazime–labeled leukocyte distribution as a function of the relative frequency of white cell types in the labeled blood. Materials and Methods A 76-year-old man who was hospitalized with fever and possible postoperative osteomyelitis underwent scintigraphic imaging with Tc-99m exametazime–labeled leukocytes. Results The white cell scan excluded any discrete focus of infection and revealed diffuse involvement of the lymph nodes and skin. The pathologic diagnosis was angioimmunoblastic T-cell lymphoma. The atypical infiltrates seen on the white cell scan can be explained by the severe eosinophilic blood count on the day of leukocyte labeling (total leukocyte count: 8,100 cells/&mgr;l with 63% neutrophils, 8.9% lymphocytes, and 22.2% eosinophils). Conclusion In the labeling of the leukocyte moiety, a higher presence of any leukocyte subpopulation will modify the biodistribution and thus the image interpretation.