case_images: PMC9763843_01
case_images: Images of the patient. The patient developed maculopapular rash on the trunk (A, B), back, hip and extremities. Eschar was detected on the left knee (black arrow, C). 99mTcHM-PAO single photon computed emission tomography (PAO-SPECT) was performed on the 5th hospital day before initiating intravenous immunoglobulin (IVIg). We detected increased cerebral blood flow in left occipital lobe, using three-dimensional stereotactic surface projection (3D-SSP) analysis (white arrows, D above). On PAO-SPECT performed on the 19th hospital day after the treatment with IVIg, the increased blood flow in left occipital lobe was reduced (white arrows, D below). The both PAO-SPECTs were performed using the following protocol: 1110 MBq of 99 mTc-HMPAO was administered, and imaging was performed on a Dual-head SPECT scanner: Symbia T2 (Siemens Japan) starting about 5 min later. Color coding represents the statistical significance (Z-score) of the increase in regional cerebral blood flow compared with age-matched normal controls. Abbreviations; RT, right; LT, left; LAT, lateral; SUP, superior; INF, inferior; ANT, anterior; POST, posterior; MED, medial.
case_images: gr1.jpg
case_images: PMC9763843_01_gr1.jpg
case_images: fig0005
case_images: He developed maculopapular rash on the trunk, back, hip, extremities, palms, and soles (Fig. 1A, B). Eschar of 4-5 mm was detected on the left knee (Fig. 1C). The increased cerebral blood flow in left occipital lobe was detected on 99 mTcHM-PAO single photon computed emission tomography (PAO-SPECT), using three-dimensional stereotactic surface projection (3D-SSP) analysis (Fig. 1D). The increased blood flow in left occipital lobe was reduced on PAO-SPECT performed 2 weeks after IVIg (Fig. 1D).