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Delineation of Peripheral Bone Infarcts in a Child with a Rare Hemoglobinopathy (SO_Arab) and Purpura Fulminans: Case Report

Johns Hopkins Medical Institutions, Baltimore, Maryland

Correspondence: For reprints contact: William C. Klingensmith III, Nuclear Medicine Service, Veterans Administration Hospital, 1055 Clermont St., Denver, CO 80220.

ABSTRACT

A 27-month-old patient with SO_Arab hemoglobinopathy complicated by purpura fulminans was studied with ^99mTc-pyrophosphate. The study showed an absence of radiotracer in the bones of both feet and the distal portions of both hands, along with an increased concentration of radiotracer proximal to the regions of absent radiotracer. Subsequent amputation of the distal portions of all four extremities was necessary because of dry gangrene. The amputation site in each extremity (selected on clinical grounds only) corresponded closely to the junction of absent and increased bone radiotracer, suggesting that bone imaging may be used as an aid in determining the extent of nonviable tissue in similar patients.