ABNORMAL BONE-SCINTIGRAPHY BEFORE CLINICAL SYMPTOMS IN A PATIENT WITH DEFECTIVE PHAGOCYTE FUNCTION

Patients with immune deficiency related to defective phagocyte function, such as hyperimmunoglobulinemia E (Job's syndrome) or chronic granulomatous disease of childhood, are susceptible to the development of serious recurrent infections. Radiographic evidence of osteomyelitis in patients with granulomatous disease of childhood before the development of clinical signs and symptoms has been documented. Similar findings with bone scintigraphy for osteomyelitis or synovitis have not been reported in patients with defective phagocyte function. This patient, with a variant of Job's syndrome, had positive findings in the hand on her bone scan prior to the development of symptoms in that area. Clinically, the lesion was thought to represent an infectious synovitis, although osteomyelitis was also suspected. When a region of increased uptake is noted on the bone scan of a patient with these types of immune deficiency syndromes, further clinical and radiologic correlation is warranted, even in the absence of symptoms.