Buttock granulomas - A consequence of intramuscular injection of sandostatin detected by In-111 octreoscan

A 64-year-old woman with a malignant carcinoid tumor began receiving monthly treatment with 30 mg long-acting Sandostatin suspension injected intramuscularly in the buttocks along with 200 μg Sandostatin (Novartis, Hanover, NJ) subcutaneously once per day in 1994. Tc-99m MDP bone imaging showed areas of extensive metastases. To better characterize the extent of disease, In-111 pentetreotide imaging was performed, with images acquired at 24 hours. In addition to widespread disease, unusual uptake was shown in the upper outer quadrants of both buttocks, apparently at the sites of intramuscular Sandostatin injection. Recent studies of single-dose intramuscular injections have shown that Sandostatin injection may lead to localized granulomatous myositis and granuloma formation. In this patient, two large areas of increased uptake located in both buttocks are seen at the sites of repeated intramuscular injection of Sandostatin.