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Indium-111-Labeled Polyclonal Human Immunoglobulin: Identifying Focal Infection in Patients Positive for Human Immunodeficiency Virus

Institute of Nuclear Medicine and Department of Medicine, University College London School of Medicine, London, England
Departments of Nuclear Medicine and Internal Medicine University Hospital, Nijmegen, The Netherlands

Correspondence: For correspondence and reprints contact: John R. Buscombe, MD, lnstitute of Nuclear Medicine, University College London School of Medicine, Mortimer Street, London W1N 8AA, England.

ABSTRACT

Pooled human immunoglobulin labeled with indium-111 (¹¹¹In HlgG)was used to identify the presence and extent of infection in patients positive for human imunodeficiency virus (HIV), presenting with either symptoms and/or signs of acute chest infection or with pyrexia without localizing signs or symptoms. Fifty-five studies were performed in 51 patients with suspected chest infection or pyrexia without localizing signs. Of these, ¹¹¹In-HlgG identified intrapulmonary accumulation in 17 patients with Pneumocystis carinii pneumonia, eight with bacterial pneumonia, five with cytomegalovirus pneumonia, three with pulmonary Mycobacterium avium intracellulare infection and one with a fungal pneumonia. There was no intrapulmonary accumulation of ¹¹¹In-HlgG in five patients with bronchopulmonary Kaposi's sarcoma and in three patients with intrathoracic lymphoma. Quantification of lung/heart activity was significantly increased (p < 0.05) in patients with active chest infection compared with those with intrapulmonary tumor or no active lung pathology. Indium-111-HlgG scintigraphy also localized at 14 sites of extrapulmonary infection, including six patients with colitis. There were no false-negative studies but false-positive uptake was seen in four studies. These results confirm that ¹¹¹In-HlgG correctly identifies the presence and extent of infection in patients positive for HIV antibody.

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