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The Role of Gallium-67-Citrate in the Detection of Phenytoin-Induced Pneumonitis

Division of Nuclear Medicine, Department of Radiation Oncology and Nuclear Medicine, Hahnemann University, Philadelphia, Pennsylvania

Correspondence: For correspondence and reprints contact: Simin Dadparvar, MD, Nuclear Medicine, MS 309, Hahnemann University, Broad & Vine Streets, Philadelphia, PA 19102-1192.

ABSTRACT

A patient with a history of cardiac transplant presented with a fever of undetermined etiology. The patient had been on multiple medications, including phenytoin, which can occasionally cause allergic or hypersensitivity pneumonitis. A chest x-ray and CT scan of the chest revealed no active disease. A ⁶⁷Ga study was obtained after intravenous administration of 377.4 MBq (10.2 mCi) of ⁶⁷Ga-citrate. The images showed diffuse intense lung uptake bilaterally. Bronchoscopic biopsy revealed hypersensitivity pneumonitis. Phenytoin was withdrawn and corticosteroid was started in therapeutic doses. A follow-up gallium study obtained 25 days after the baseline demonstrated marked improvement in the lungs with concurrent clinical recovery. This case illustrates the usefulness of ⁶⁷Ga in the detection of drug-induced pneumonitis and in the follow-up of response to therapy.

Key Words: phenytoin • pneumonitis • gallium-67