Tracheitis Diagnosed With 68 Ga-PSMA PET/CT in a Patient With COVID-19.

ABSTRACT: A 57-year-old man with newly diagnosed with prostate cancer was admitted to our department for 68 Ga-prostate-specific membrane antigen PET/CT imaging. The patient, who was asymptomatic at the time of imaging, had increased diffuse 68 Ga-prostate-specific membrane antigen uptake in the trachea on PET/CT. No ground-glass density suggestive of pneumonia in both lungs was observed. The patient, whose symptoms developed 2 days after PET/CT imaging, was diagnosed with coronavirus disease 2019 by real-time polymerase chain reaction.

A 57-year-old man, newly diagnosed with prostate carcinoma with a Gleason score 3 + 4, was admitted to our department for 68Ga–prostate-specific membrane antigen (PSMA) PET/CT imaging for staging purpose. Total prostate-specific antigen value at the time of PET/CT imaging was 10.1 ng/dL. Diffusely increased 68Ga-PSMA uptake in the trachea and bilateral main bronchi was observed (SUVmax, 3.6) (as shown by the red arrows; A, MIP images; B, Fusion PET/CT transaxial image; C, PET transaxial image; D, CT transaxial image). Increased 68Ga-PSMA expression of primary malignancy was observed in the prostate gland (SUVmax, 5.7) (E, fusion PET/CT transaxial image; F, PET transaxial image; G, CT transaxial image) with PET/CT; no metastatic lesion of prostate cancer was visualized. There were no ground-glass opacities in either lung. Although the patient did not have any symptoms just before imaging, 2 days after PET/CT, the patient described weakness, fever, sore throat, pain with swallowing, yellow purulent sputum, and joint and bone pain. The patient was evaluated in terms of possible respiratory tract infections; real-time polymerase chain reaction test was performed, and coronavirus disease 2019 (COVID-19) was detected. Although 68Ga-PSMA is used as an ideal molecular target for both diagnosis and treatment of prostate cancer, PSMA expression is not specific to prostate cells and can be seen in benign processes such as inflammation or infection.[1-3] Cases of COVID-19 pneumonia have been reported incidentally in prostate cancer patients undergoing 68Ga-PSMA PET/CT imaging.[4-8] However, to our knowledge, there was no report of isolated tracheal PSMA involvement in patients with COVID-19 in the literature before. Tracheal 68Ga-PSMA uptake seen on PET/CT in asymptomatic patients may raise suspicion for possible COVID-19 disease.