FDG-PET/CT for a Variety of Infectious Diseases

A 70-year-old man presented with right mandibular pain and history of right mandibular third molar extraction 20 months back. Examination revealed purulence, exposed bone, and mental nerve hypoesthesia. He was previously prescribed zoledronate to treat bone metastases from pulmonary adenocarcinoma. PET/CT images taken 5 months before the first visit demonstrated increased mandibular FDG uptake. The inflammation remained symptomatic despite zoledronate discontinuation and antibiotic administration, with left mandibular bone exposure. SPECT/CT images demonstrated increased MDP uptake and bilateral mandibular bone destruction. Mandibular resection and pathological investigation revealed a sequestrum, indicating chronic osteomyelitis, leading to diagnosis of ARONJ (stages III and I).